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How can a doctor cope with stress at work?
Yuri Domodedonenko
Galina Ivanova
Psychotherapist, Candidate of Medical Sciences, Associate Professor of the Department of Psychiatry, Narcology and Psychotherapy of the Faculty of Postgraduate Education of the Moscow State Medical University named after. A.I. Evdokimov.
The medical profession is traditionally one of the ten most stressful activities: it is associated with a sense of responsibility for the patient’s life, fear of making a mistake, tension and anxiety.
In normal times, high levels of fatigue, emotional exhaustion, and tension are noted by Psychological characteristics of doctors in a state of professional stress in up to a quarter of doctors, and in times of COVID-19, stress-related symptoms are identified Online mental health services in China during the COVID-19 outbreak already in 73% of medical workers.
What causes stress and how does it manifest itself?
Stress is a nonspecific reaction of the body to extreme stimuli (stressors). For doctors, such extreme and often chronic irritants are contact with the suffering of patients, their death, intense workload, unstable work schedule, piles of paperwork, a feeling of legal insecurity, lack of support from management and colleagues, conflicts with patients and their relatives.
All these are “external” causes of stress, but there are also “internal” triggers based on a person’s system of values and aspirations, which are activated during a destructive collision of the doctor’s system of moral guidelines with a rough, harsh, unfair reality.
Then a high level of responsibility, perfectionism, dissatisfaction with one’s own social and financial situation, the experience of injustice or the inadmissibility of what is happening trigger a stress reaction.
For example, this is how dissatisfaction with the results of one’s work arises, associated with the influence of external factors: “I am a doctor, not a secretary, because of these papers of yours I have no time to treat,” “I brought my gastritis in a Mercedes, and he kicked the door open for me.”
For medical workers, professional stress makes itself felt through irritability, short temper, nervousness, anxiety, feelings of insecurity or helplessness, decreased mood up to depression, and sleep disturbances.
Problems with concentration often arise, memory and attention are impaired, interest in work disappears, and it becomes difficult to motivate yourself to do something important. Later, various psychosomatic disorders appear.
And then comes professional burnout - a state of emotional, physical and mental exhaustion in which the doctor can no longer perform his job with the same efficiency and does not feel satisfied with his own life.
Watch your diet
An incorrectly composed diet is additional stress for the body. Therefore, make sure that your menu has enough vitamins and microelements, eliminate or at least limit harmful foods. This is especially true for table salt. Excess salt changes the functioning of the adrenal glands, the organs that are responsible for the production of adrenaline and cortisol, the so-called stress hormones. If the adrenal glands do not work properly, excess amounts of these hormones enter the blood. And they, in turn, negatively affect all organs and systems.
Another ally of stress is alcohol. The fact is that every glass of alcohol increases the load on the liver. As a result, the brain does not receive the necessary nutrients, but receives toxins in abundance. And he is no longer able to give the necessary commands to the internal organs. It is no coincidence that all drinkers have approximately the same reaction to stress - they are irritable, fussy, and unable to make adequate decisions. All this is the result of alcohol.
You should not lean on too fatty fried foods. It, like alcohol, causes the liver to work harder.
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How a doctor can cope with stress
Fortunately, all these troubles are surmountable and reversible. There are techniques and methods of prevention that allow you to cope with stress at work.
- The most important thing is to take care of yourself, your mental and physical well-being. Rest on time, eat on time and of good quality, get enough sleep, maintain relationships with loved ones and friends, communicate with interesting people, play sports and your hobbies. Taking breaks from work is not selfish, but rational. The needs of surviving patients are no more important than your own needs and your well-being.
- Remember your own values. Be aware of ideas that you can rely on in difficult times: why you became a doctor, what you can bring to other people, what good things you know about yourself, what you believe in.
- Draw boundaries and don't be afraid to say no when you're not ready or able to respond to someone's request. Don't take on someone else's responsibilities, no matter how dedicated you are to the cause you serve. It is necessary to know your rights and responsibilities and insist on ensuring the required working conditions.
- Contact us for support. If possible, talk to your loved ones and friends about your fears and concerns. Discuss the problem with colleagues, with management, in the professional community. There is always someone who can help you with action or advice, and you can ask for it.
- Watch what you think. Catch the disturbing ideas, become aware of any negative thoughts about yourself and ideas of self-judgment and question them: is it true, is it about you, what is the situation really like. Be your own advocate, not your own prosecutor.
- Track changes in your mood. Try to determine what events, actions of others, what words or even your own thoughts became the impetus for anxiety, anger or depression.
- Learn to feel your bodily reactions and identify discomfort. Try to understand how they are connected to your mood and the events of the past day. Sometimes we “confuse” the needs of the body and rush, for example, to satisfy the feeling of hunger, when in reality we are sad and lonely.
- Get to know your stress. Understanding what causes you stress, how you react to it, where it all begins, what or who can help you, allows you to feel less helpless, easier to bear stress, and continue to help other people.
- Focus on those things that are under your control and within your control. Try to celebrate your successes, big and small, even if they seem insignificant.
- Remember to have a sense of humor, even if it is dark. This is a great way to change your perception of a stressful situation. For example, psychiatrists have a joke: “Whoever puts on a robe first today is the psychiatrist.” They say it helps you recover at the end of a hard day.
- Do not use alcohol or other substances to self-medicate. All this brings only a temporary feeling of relief and a lot of side effects in the short and long term. Don't overuse caffeine and avoid overeating.
- Learn techniques for relaxation. These can be breathing exercises, autogenic training, techniques of conscious introspection, meditation. They help reduce internal tension, anxiety, improve sleep, and improve physical well-being. You can do yoga, qigong, tai chi, or just swim.
- Let patients just be patients. A problem patient does not come specifically “for your soul” - he brings his illness to you and talks about his suffering in ways that are accessible to him. Even if he doesn’t know how to greet you politely, demonstrates his high position or intimidates you, his gastritis is no different from hundreds of other gastritis. Remember, you came to work early and already had time to put on your robe.
- Seek professional help. Be sure to do this if you feel that internal discomfort is increasing over time, your mood remains steadily depressed, you cannot cope with manifestations of emotions, and it is becoming increasingly difficult to work. Do not rush to refuse the medications suggested by your psychotherapist for anxiety or depression. They work and effectively help to survive the acute phase of stress, chronic stress and their consequences.
To maintain confidentiality, you can contact a specialist outside your institution or get advice online. Since the beginning of the COVID-19 epidemic, dozens of government, public and private organizations have provided free psychological assistance to medical workers in various forms. For example, the Psychological Support Group for medical workers working with COVID-19 at the Association of Cognitive Behavioral Therapists.
Sleep at least 6 hours
Sleep is necessary for the body to restore strength. If there is not enough rest, then the reaction to stress will be inadequate.
In addition, lack of sleep combined with stress can cause heart attacks, strokes, and thrombosis. But remember, sleeping too long is also bad for your health. The connection between the occurrence of senile dementia, Alzheimer's disease and other vascular diseases and sleep more than 10 hours a day has been scientifically proven.
Most people need 6-8 hours of sleep, but sleep needs vary depending on age and individual characteristics. Finding out how much recovery time you need is not difficult at all. Go to bed around 10–11 pm (by the way, in order not to disturb the correct biorhythms, you need to go to bed no later than 12 am) and sleep until the morning, without turning on the alarm clock. If you wake up in a good mood, with a feeling of vigor, it means you slept enough. Just don't lie in bed after waking up. You may be able to fall asleep again, but such a dream will not bring anything other than a feeling of weakness.
Various gadgets will also help you control your sleep. Special smart bracelets are capable of measuring heart rate and determining the stages of sleep depending on the movements of your body. Such a bracelet, synchronized with an application on your mobile phone or computer, will not only calculate the number of hours you need to rest, but will also wake you up at the right moment. After all, your well-being depends on what stage of sleep, deep or superficial, you wake up in. The fact is that waking up during deep sleep is stressful in itself!
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Play sports
Physical education is like stress in miniature. First, the body mobilizes, then adapts, and finally rests. That is, it goes through all the same stages as during stress. Therefore, people who lead an active lifestyle and play sports are more adapted to meeting an unusual situation.
In addition, during training a person begins to breathe deeply and correctly. And breathing exercises are one of the best sedatives. When you inhale deeply and exhale slowly, carbon dioxide is formed, which has an anti-anxiety effect.
