Dealing With Stress

It can be disconcerting to realize that physicians have a higher suicide rate than the general population or other academics. Although that’s largely been an anecdotal statement, a paper published in 2004 in the American Journal of Psychiatry (Schernhammere ES, Graham AC. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis. Am J Psychiatry. 2004;161:2295-2302.) found that male physicians did indeed have a slightly elevated suicide rate and female physicians had a highly elevated suicide rate.

Louise B. Andrew, MD, JD, writing on eMedicine in March 2010, cites that “the United States loses the equivalent of at least 1 entire medical school class each year to suicide (reliable estimates are as many as 400 physicians).”

Practicing medicine is a high-stress profession. Although physicians often appear to be in control, that in itself can create stress. And of course, there’s a great deal of stress involved in dealing with sick and often dying people on a regular basis. Throw in the complexities and pressures of declining reimbursements, running a business and the potential for devastating lawsuits hanging over your head, and it’s not surprising that many physicians have problems with stress that can lead to depression and other health problems, like headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart disease and stroke.

It’s hard to define stress, though. What one person finds stressful, another person finds exhilarating. Researchers, however, have tied 85%–90% of all visits to primary care physicians with stress-related conditions. Or put it this way: 112 million people take medication to deal with stress-related symptoms. Here are 10 ways to deal with stress.

1. Cut the Caffeine. Yes, start right out with a tough one. But caffeine has been indicted in numerous stress-related conditions. And caffeine is found in coffee, tea, chocolate and colas. These days, even bottled waters and energy drinks are suffused with caffeine. Wean yourself off caffeine gradually, so you don’t get withdrawal headaches, then take about 3 weeks to see whether your stress level has decreased. If it has, good; if it hasn’t, go back to drinking caffeine if you must and look at other ways to cut stress.

2. Exercise. Our reaction to stress, the “fight-or-flight” mechanism, causes our body to react in a way that would precede activity; but mostly we’re not in an active mode, we’re dealing with patients, staff, endless paperwork or deadlines. Exercising is a logical way to bleed off the excess energy created by stress. Typically, aerobic exercise is recommended for a minimum of 3 times per week for a minimum of 30 minutes each. Aerobic activities include walking, jogging, bicycling, skiing, aerobics, dancing or swimming, among others.

3. Relaxation and Meditation. There are a number of different relaxation exercises. For some, it might be medication, self-hypnosis, sitting by a fire, reading a book, lying in a hammock, petting a family pet, sitting by a lake or praying. Some people find reading books or listening to music relaxing.

4. Sleep. Nothing can be quite as relaxing as a nap, as long as it’s short enough not to screw up your sleep cycle — that usually means 30 minutes or less. If you already struggle with insomnia, it’s best to stay away from naps. In addition, most people don’t get enough sleep. The average is between 7 and 8 hours of sleep a night. If stress is getting to you, going to bed 30–60 minutes earlier might do the trick.

5. Leisure and Time-Outs. Certainly, you’ve heard that all work and no play made Dr. Jack a dull boy, right? There’s a balance that needs to be made — even or especially for physicians — between your work and your play. Everybody needs a break from time to time. The so-called conveniences of the modern age — the Internet, laptop computers, email and smartphones — have made it so easy for us to take our work with us everywhere we go, at home, in the car, on vacation, that we never take time off.
   
   This can apply to taking a couple 20-minute breaks each day during your workday, or getting out of the office for a walk, run or a visit to the gym; or a longer time, such as a vacation where you don’t bring a laptop with you and don’t check your email every 15 minutes (or even until you get back home). Generally speaking, the less leisure you have, the higher your stress level.
   
   Divide your life into 4 segments: Work, family, community and self. (Exclude sleep time.) Now, calculate what percentage of your time you spend on each. There’s no normal range, but if you’re spending more than 60% of your time on work and less than 10% on self, you might be headed for trouble. Give yourself permission to take a break. Did you know that the word “leisure” is derived from the Old French word “leisir,” which means “to be permitted”? Permit yourself some leisure time.

6. Get Realistic. Unrealistic expectations cause stress. Expect to make a million dollars your first year in practice? Expect to cure all your patients? Are there areas in your life, whether work or personal, where your expectations are so high that nobody could reach them? Consider adjusting your expectations. Life will be much less stressful.

7. Reframe. Simply put, reframing can be summed up by the classic question: Is the glass half empty or half full? It’s all about perspective and point of view. This can be tough, but it’s helpful to look at the causes of your stress and decide whether they are really stressful or if it’s your reaction to them that’s stressful. Some people find roller coasters a thrill; others find them stressful. Reframing doesn’t change the cause of the stress, but it changes how you perceive it and deal with it.

8. Beliefs. This doesn’t quite mean your religious or spiritual life, although it can. What this refers to is the many things you believe about life and the way the world and the universe works. If you believe that politicians are all liars, that’s a belief that can color all your experiences with government. If you believe that a good father is one who provides for his family, then that colors your experiences and approach to life — and how you perceive yourself. Mostly, we aren’t aware of our beliefs because they’re so integrated into our ways of thinking.
   
   These belief systems can cause stress, first by the behavior they inspire and, second, by how they conflict with the belief systems of other people. It’s amazing how seemingly simple some of these belief systems can be. For instance, perhaps a person believes that in order for a house to be clean, it needs to be vacuumed and dusted every day. That takes up a fair amount of time and a person who thinks once a week is fine doesn’t understand why the person who does might feel like a failure (or that the house is a mess) if it isn’t thoroughly cleaned daily.
   
   Being aware of our own beliefs and assumptions and restructuring them can go a long way toward decreasing unintentional stress in our lives.

9. Support System. Do you deal with stress alone? Or do you share it with someone? Do you have a friend, colleague, religious leader, counselor, spouse or family member you can go to when you’re stressed? Sometimes all we need is a listening ear.

10. Humor. Laughing relieves tension. Seeing some of the tensions in the world in a humorous light can make dealing with them significantly easier. Laughter, you know, lightens the load. Did you hear the one about the patient who came into the doctor’s office with a carrot up his nose, a cucumber in his left ear and a rutabaga in his right ear?

Above all, if the stress is getting to be too much, get help. Don’t go it alone. Talk to your own doctor, see a counselor, psychiatrist, psychologist, religious leader or friend. You don’t want to be a statistic.

Action Step: One day a month for 12 months, list something you will do to reduce your stress. Each week between that day, write a progress report on how your stress reduction assignment is working.

Excerpted from 31½ Essentials for Running Your Medical Practice by John Guiliana, DPM, MS; Hal Ornstein, DPM, FASPS; and Mark Terry.