Stress Management Or not

What Am I Going to Do? Big subject. Think about what we mean by stress. Think about why things stress us. Look at some evidence about stress and doctors. Suggest some ways of reducing its deleterious effects. August 2001 Bruce Davies

What do we mean by stress? Biological meaning Social meanings Medical meanings Media meanings Real or imaginary? August 2001 Bruce Davies

New Problem or Old? Perceptions. “Modern life.” Is war, poverty or crime stressful? Stressors for me, stimulation for you. Physiological endpoints are the same. August 2001 Bruce Davies

Stress: problem or motivator August 2001 Bruce Davies

Effects of Stress Physical. Mental. Social. Societal. August 2001 Bruce Davies

What Evidence Is There? More than you’d think. Must remember all the “non-medical sources”. What follows is a quick summary of the more important doctor specific research. August 2001 Bruce Davies

Evidence Main stresses are. The demands of the job, Patient expectations, Interference with family life, Interruptions at work. Work at home. Dealing with administration. May be substantial benefit in providing a counselling service for GPs. C Cooper et al BMJ 1989; 298: 366-70 August 2001 Bruce Davies

Evidence 10 minute appointments put general practitioners under less stress when compared with the doctors' usual booking intervals of between 5 and 7.5minutes. Stress can cause burnout or “rustout”. It seems to be getting worse. A Wilson et al BJGP 1991; 41: 184-7 TC O'Dowd JRCGP 1987; 37: 290 VJ Sutherland and CL Cooper BMJ 1992; 304: 1545-8 VJ Sutherland and CL Cooper BMJ 1992; 304: 1545-8 August 2001 Bruce Davies

Evidence GPs doing more paperwork at home then they and report more exhaustion or stress at the end of a working week. R Chambers and J Belcher BJGP 1993; 43: 410-12 August 2001 Bruce Davies

Recognising Symptoms Physical signs. Emotional signs. Behavioural signs. August 2001 Bruce Davies

Taking Control Work pattern. Home / work. Work environment. Managing time. Routines of work. August 2001 Bruce Davies

Expectations Cultural differences. Learning to say no. Setting your standards. The work play dichotomy. August 2001 Bruce Davies

Exercise At work. At home. Learning to relax. Why does it help? August 2001 Bruce Davies

Time Out Housekeeping. Gaps. DNAs Other work. Holidays. August 2001 Bruce Davies

Hobbies Outside interests. If medicine your life – do they matter? Why helpful? August 2001 Bruce Davies

Solutions ? T aking control E xpectations E xercise T ime out H obbies August 2001 Bruce Davies

PROFESSIONAL BURNOUT D Kelly Update 15th June 1992 1163-1170 Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific August 2001 Bruce Davies

Does Talking About It, and Studying It Make It Worse? Stress Management Does Talking About It, and Studying It Make It Worse?

Last Thoughts. Good trend: Unexpected bad thing: Computers allow us to work 100% faster Computers generate 300% more work. Women get more political power. Women are as dumb as men. Music continues to get better. I get old. Bruce Davies

Thankyou August 2001 Bruce Davies

MENTAL HEALTH, JOB SATISFACTION AND JOB STRESS AMONG GENERAL PRACTITIONERS C Cooper et al BMJ 1989; 298: 366-70 Main stresses are the demands of the job, patient expectations, interference with family life, interruptions at work and home and dealing with administration. Concludes that there may be substantial benefit in providing a counselling service for GPs (and other health workers.) August 2001 Bruce Davies

LONGER BOOKING INTERVALS IN GENERAL PRACTICE: EFFECTS ON DOCTORS' STRESS AND AROUSAL A Wilson et al BJGP 1991; 41: 184-7 10 minute appointments put general practitioners under less stress when compared with the doctors' usual booking intervals of between 5 and 7.5minutes August 2001 Bruce Davies

TO BURN OUT OR RUST OUT IN GENERAL PRACTICE? TC O'Dowd JRCGP 1987; 37: 290 August 2001 Bruce Davies

VJ Sutherland and CL Cooper BMJ 1992; 304: 1545-8 JOB STRESS, SATISFACTION, AND MENTAL HEALTH AMONG GENERAL PRACTITIONERS BEFORE AND AFTER INTRODUCTION OF NEW CONTRACT VJ Sutherland and CL Cooper BMJ 1992; 304: 1545-8 Comparing 1987 with 1990, GPs experienced more stress from night calls, emergencies during surgery hours and interruption of family life by the telephone. Somatic anxiety and depression were both higher and job satisfaction had also decreased. August 2001 Bruce Davies

PSYCHOLOGICAL STRESSES OF BEING A DOCTOR P Whewell Update 1st June 1992 pp1003-4 (references continued on p1071) A review of the problems with some suggestions for coping and finding help. August 2001 Bruce Davies

PROFESSIONAL BURNOUT D Kelly Update 15th June 1992 1163-1170 Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific August 2001 Bruce Davies

R Chambers and J Belcher BJGP 1993; 43: 410-12 WORK PATTERNS OF GENERAL PRACTITIONERS BEFORE AND AFTER THE INTRODUCTION OF THE 1990 CONTRACT R Chambers and J Belcher BJGP 1993; 43: 410-12 This paper indicates the changes resulted in GPs doing more paperwork at home and reporting exhaustion or stress at the end of a working week. August 2001 Bruce Davies

STRESS, ANXIETY AND DEPRESSION IN HOSPITAL CONSULTANTS, GENERAL PRACTITIONERS, AND SENIOR HEALTH SERVICE MANAGERS RP Caplan BMJ 1994; 309: 1261-3 A worrying, but not surprising set of results. Action detectable anywhere? What interventions might work? What interventions have been shown to work? August 2001 Bruce Davies