How can a doctor deal with stress at work?

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Galina Ivanova

Psychotherapist, Candidate of Medical Sciences, Associate Professor of the Department of Psychiatry, Narcology and Psychotherapy, FDPO MGMSU named after A.I. Evdokimova.

The medical profession is traditionally one of the ten most stressful activities: it is associated with feeling the burden of responsibility for the patient's life, fear of making a mistake, with tension and anxiety.

At normal times, a high level of fatigue, emotional exhaustion, stress is notedPsychological characteristics of doctors in a state of professional stress at home up to a quarter of doctors, and during COVID-19, stress-related symptoms come to lightOnline mental health services in China during the COVID-19 outbreak already in 73% of medical workers.

What causes stress and how it manifests itself

Stress is a non-specific 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, paperwork, a sense of legal insecurity, lack of support from management and colleagues, conflicts with patients and their relatives.

All of these are “external” causes of stress, but there are also “internal” triggers based on a system of values, human aspirations, which are activated in the destructive collision of the system of moral guidelines of the doctor with a rude, 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 stressful 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, but I’m not a secretary, because of these papers of yours I have no time to heal ”,“ I brought my gastritis on a Mercedes, and it kicks me open the door ”.

For healthcare workers, occupational stress makes itself felt by irritability, irascibility, nervousness, anxiety, feelings of insecurity or helplessness, decreased mood up to depression, sleep disorders.

Often there are problems with concentration, memory and attention are impaired, interest in work disappears, it becomes difficult to motivate yourself to do something important. Later, various psychosomatic disorders join.

And then professional burnout sets in - a state of emotional, physical and mental exhaustion, with which the doctor can no longer perform his work with the same efficiency and does not feel satisfaction from his own life.

How a doctor can deal with stress

Fortunately, all these troubles are surmountable and reversible. There are prevention techniques and strategies to help you manage stress at work.

1. The most important thing is to take care of yourself, your mental and physical well-being. Rest on time, eat in a timely manner and with good quality, get enough sleep, maintain relationships with family and friends, communicate with interesting people, play sports and do your hobbies. Taking breaks from work is not selfish, but rational. The needs of the surviving patients are no more important than your own needs and your well-being.
2. Remember your own values. Be aware of ideas that you can rely on in difficult times: why did you become a doctor, what you can bring to other people, what good you know about yourself, what you believe in.
3. Draw boundaries and don't be afraid to say no when you're not ready or able to respond to someone's request. Do not take on someone else's responsibility, no matter how committed you are to the cause you serve. You need to know your rights and responsibilities, insist on ensuring the proper working conditions.
4. Get support. If possible, talk to your loved ones and friends about your fears and worries. Discuss the problem with colleagues, with management, in the professional community. There is always someone who can help you with business or advice, and you can ask for it.
5. Watch what you think. Catch disturbing ideas, be aware of any negative thoughts about yourself and ideas of self-condemnation and question them: is it true, is it about you, what is the situation in reality. Be a lawyer for yourself, not a prosecutor.
6. Track your mood changes. Try to identify what events, actions of others, what words or even your own thoughts triggered anxiety, anger, or depression.
7. Learn to feel your bodily reactions, identify discomfort. Try to understand how they relate to your mood, to the events of the past day. Sometimes we "confuse" the needs of the body and are in a hurry, for example, to satisfy the feeling of hunger, when in reality we are sad and lonely.
8. Get to know your stress. Understanding what causes you stress, how you react to it, how it all starts, what or who can you help, makes you feel less helpless, tolerate stress more easily, and continue to help others people.
9. Focus on those things that are under your control and within your reach. Try to celebrate your big and small successes, even if they seem insignificant.
10. Remember your sense of humor, even if it's black. This is a great way to change your perception of a stressful situation. For example, psychiatrists have a joke: "Whoever put on a robe today is also a psychiatrist." They say it helps to recover well at the end of a hard day.
11. Do not use alcohol or other substances for self-medication. All this brings only a temporary feeling of relief and a lot of side effects in the short and long term. Don't abuse caffeine and avoid overeating.
12. Learn relaxation techniques. It can be breathing exercises, autogenous training, methods of conscious self-observation, meditation. They help to reduce internal tension, anxiety, improve sleep, and improve physical well-being. You can do yoga, qigong, tai chi, or just swim.
13. Let the patients be just patients. A problem patient does not come specially "for your soul" - he brings his illness to you and speaks about his suffering in the ways available to him. Even if he does not know how to greet 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 have already put on your robe.
14. Get professional help. Be sure to do this if you feel that internal discomfort increases over time, the mood remains steadily low, you cannot cope with the manifestations of emotions, it becomes more and more difficult work. Do not rush to give up the drugs suggested by the psychotherapist for anxiety or depression. They work and effectively help to cope with the acute phase of stress, chronic stress and its consequences.

To maintain confidentiality, you can contact a specialist outside of your institution or get advice online. With the onset of the COVID-19 epidemic free psychological assistance dozens of state, public and private organizations provide medical workers in various forms. For example, the Cognitive Behavioral Therapists Association of Cognitive Behavioral Therapists is the Psychological Support Group for Healthcare Professionals working with COVID-19.