Prescription for doctors: How to manage and reduce stress levels at work

 

  “Only a life lived for others is a life worthwhile.” Albert Einstein

 

The most rewarding moment for a doctor — who had put in all his effort, fighting off his exhaustion to save a life — is when a patient expresses his gratitude with a smile.

In India, doctors are often equated to god. It is a very challenging profession both physical and psychological terms as medical practitioners have to be available for patients round the clock.

Violence on doctors by kin of patients adds to stress levels of medical practitioners

Although doctors don’t usually complain about stress they undergo as part of their profession, dismiss it as an occupational hazard, studies have shown that stress is taking a heavy toll on their lives.

According to a recent article published in Medical Dialogues, a study conducted among doctors by the psychiatry department of Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, found that out of 442 respondents 90 per cent were stressed out and 10 per cent were “overwhelmingly stressed”.

The study also found that there were number of diverse issues during work which includes long working hours, lack of recognition at work and no leave and blaming for mistakes they had not committed. Apart from these, doctors reportedly used to consume cannabis, opioids, cigarettes, and alcohol as a stress-buster.

Stress is inevitable, but it is mismanaged stress that is damaging the whole system. There is now much attention on measures that promote mental health and wellbeing in doctors, and prevention of stress-related morbidity.

A recent IMA study said doctors faced maximum violence when providing emergency or critical services, with over 48 per cent of such incidents reported from intensive care units (ICUs) or post-surgery care units. Over 65 per cent of such violent acts are performed by relatives of patients. Moreover, around 40 per cent doctors witnessed assault at least once in their career. Recently India witnessed the brutal assault on a junior doctor in Kolkata which led to a massive strike of 800,000 doctors demanding better working conditions, following years of complaints about violent attacks from patients’ families. Theses strikes and agitations are the output of prolonged Stress experienced by doctors. But this significant problem may not be receiving enough attention because we have a perception that they may be quite adept at handling stress through their medical training, but this is not the case always. The stress that many doctors face is far beyond this.

Other factors which cause stress among doctors are handling superiors and lower staff, work pressure from management when the expected income not generated by a specific doctor (private sector), doing administrative work, patient agony and counselling, patient attenders management, poor working conditions, work-family balance, death of patients, wrong information in social media vitiating the doctor-patient relationship. All these factors of stress badly affect them which leads to physical, psychological and behavioural reactions or even to psychosomatic diseases. Stress is inevitable, but it is mismanaged stress that is damaging the whole system. There is now much attention on measures that promote mental health and wellbeing in doctors, and prevention of stress-related morbidity. We all want our doctors to be at their best, including for themselves, too.

It is widely believed that doctors need to harden their hearts and not get too close to the suffering around them otherwise they will experience burnout. But the reality is that doctors keep their hearts open without becoming overwhelmed. This is called compassion. It is not sympathy or empathy.

What is the solution?

In considering preventive measures, the first and most important one is to include Interpersonal skills in the medical curriculum, as now there is much focus on diagnosis and treatment. Hospitals can conduct workshops on time management, mindfulness based stress reduction and stress management. It is widely believed that doctors need to harden their hearts and not get too close to the suffering around them otherwise they will experience burnout. But the reality is that doctors keep their hearts open without becoming overwhelmed. This is called compassion. It is not sympathy or empathy. It means the presence and engagement which meet the requirements for an entire conversation. Doctors have to undergo Compassion Training (CT), an effective stress management method, which build to manage the emotions, develop the resilience to prevent empathy fatigue, improving the personal relationship, supporting health and happiness thereby reducing stress and create a positive atmosphere.

Doctors themselves also have a role to play in looking after their own mental health and managing stress. Self-help strategies are often adequate without having to seek outside assistance. Some of them are as follows

  1. Meditation, physical exercises that stimulate the production of endorphins or feel good chemicals.
  2. Do something that change the mood like tasting a favourite food or talk with your close friend can bring lasting benefits.
  3. Engage in right kind of social support
  4. Accept that mistakes may happen, but do the best and continue
  5. Focus on self-care which helps the patients to do the same
  6. Proper communication with patients

 

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