Effective Ways to Handle Medical Practice Workplace Stress

It may seem to you that there is little or nothing that you can do about the stressors you face in your medical practice. There is always so much to do. Working with patients who are anxious or frightened, short-staffing, emergencies, a crowded appointment schedule—all of this can make for a stressful work environment. Fortunately, there is quite a bit that the medical practice employee can do to reduce and manage his or her own stress.

This article defines workplace stress and explains the difference between a workplace stressor and a challenge. It identifies the most common sources of workplace stress and how employees who work in a medical practice can use journaling to pinpoint their own particular stressors and stress responses. It describes the relationship between stress and health, and lists common physical and emotional responses to stress. Finally, this article provides recent statistics about workplace stress and offers 25 specific techniques and strategies that medical practice personnel can use to reduce and manage their own workplace stress.

Job stress has become a common and costly problem in the American workplace, including the medical practice. In fact, workplace stress has become so common that it is unusual in many employment situations if an employee isn’t stressed at work. Many medical practice employees have told me that there’s nothing they can do about their workplace stress level, even while admitting to me that they know that excessive stress interferes with their productivity and compromises their physical and emotional well-being. Recently, for instance, one medical practice manager told me that she never has time to eat lunch at work because her job is too demanding and stressful. Nonetheless, she said she was well aware that skipping lunch and the much-needed break was doing her harm.

Fortunately, every person working in a medical practice has a lot of control over his or her stress, more so than many realize. In fact, the simple realization that we’re in control of our lives and our stress is the foundation of workplace stress management. Managing stress, then, is all about taking charge—taking control of our thoughts, our emotions, our schedule, our environment, and the way we deal with the inevitable problems that come our way. The key is to believe that there are things we can do to manage and reduce workplace stress and then to work actively to do them.

Nearly one-half of large companies in the United States provide some type of stress management training for their workforce. Some have employee assistance programs to provide individual counseling for employees who are having difficulty handling stress. While medical practices typically do not have the resources to offer their employees such training and support, workforce stress management education is nonetheless very important.

Therefore, we will explore in the following pages the sources of workplace stress, how you can identify your own particular workplace stressors, the connection between workplace stress and your health, and 25 practical techniques you can use to reduce and manage your own stress working in your medical practice.

WHAT IS WORKPLACE STRESS?

Workplace stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. It is often confused with challenge, but these concepts are not the same and have very different effects on us.

Many people cope with stress in ways that compound the problem.

Challenge energizes us psychologically and physically, and can motivate us to learn new skills and master our jobs. When we meet a challenge, we feel relaxed and satisfied. Workplace stress is different. The challenge turns into job demands that cannot be met, relaxation turns into exhaustion, and a sense of satisfaction turns into feelings of stress. When people feel overwhelmed by stress, they find their work less rewarding. They lose confidence and become irritable, argumentative, withdrawn, careless, less productive, and less effective. They also are more likely to get sick and make mistakes. In short, workplace stress sets the stage for illness, injury, job dissatisfaction, and/or job failure.

IDENTIFY THE SOURCES OF WORKPLACE STRESS

Certain working conditions are stressful to most people. For example, excessive workload demands and conflicting expectations are workplace situations that most everyone will find stressful. However, such situations are not the norm. Apart from universally stressful workplace situations such as these, differences in individual characteristics such as personality and coping style are the most important factors in predicting whether certain job conditions will result in stress. In other words, except for universally stressful workplace situations, what is stressful for one person may not be stressful for another.

There is no “one size fits all” solution to managing stress.

Workplace stress management begins with identifying the sources of stress and your own particular hot buttons. This is not as easy as it sounds. Your true sources of stress may not be obvious to you. It’s very easy to discount your own stress-inducing thoughts and behaviors. For example, you may know that you’re constantly stressed about staying on a tight schedule or meeting ambitious deadlines. Clearly, a jam-packed appointment schedule or a project that has to be done triple-time is stressful. However, it may be possible that your own procrastination, fears, expectations, insecurities, or guilt and not only the actual job demands are contributing to your stress. That’s why it is so important to look closely and objectively at your habits, attitudes, and excuses.

When you’re well-rested, it’s much easier to keep your emotional balance.

Many people find it helpful to keep a stress journal to help them identify their true stressors and the ways they deal with them. Each time you feel stressed, keep track of it in a journal. As you keep a daily log, look for patterns and common themes. Record what caused your stress (guess if you don’t know), how you felt (physically and emotionally—be specific), how you acted or didn’t act, and what you did, if anything, to make yourself feel better. Pay particular attention to journal entries that suggest that you explain away your stressors and don’t deal with them directly.

Also, look for entries that suggest that you define stress as an integral and inevitable part of your job. (“Things are always crazy around here.”) Also note journal entries in which you blame others or outside events or when you view the stress as normal and unexceptional. Finally, use your journal to help you identify the techniques you use to cope with stress and evaluate whether they are healthy or unhealthy, productive or unproductive.

WORKPLACE STRESS AND HEALTH

Unfortunately, many people cope with stress in ways that compound the problem. Examples of unhealthy ways to cope with stress include but are not limited to:

• Apathy;

• Feeling anxious, irritable, or depressed;

• Ignoring your feelings; and

• Filling every minutes of the day to avoid facing problems.

• Smoking;

• Using alcohol or drugs to relax;

• Over- or under eating;

• Social withdrawal;

• Sleeping too much;

• Procrastinating;

• Taking out your stress on others;

• Zoning out in front of the TV;

The effects of workplace stress on chronic diseases are more difficult to see. Nonetheless, evidence is rapidly mounting to suggest that stress plays an important role in several types of chronic health problems that include cardiovascular disease, musculoskeletal disorders, and psychological disorders. Some studies suggest a relationship between stressful working conditions and suicide, cancer, ulcers, and impaired immune function. In fact, healthcare expenditures are nearly 50% greater for workers who report high levels of stress.

25 TECHNIQUES AND STRATEGIES FOR REDUCING AND MANAGING WORKPLACE STRESS

Since everyone has a unique response to workplace stress and the stressors of working in a medical practice vary from practice and practice and person to person, there is no “one size fits all” solution to managing stress. No single method works for everyone or in every medical practice. Therefore, it’s important that you experiment with different techniques and strategies. Remember though, if your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find healthier ones.

Look for the opportunity in every stressor.

There are many healthy ways to manage and cope with stress but they all require change. You can either change the situation or change your reaction. If you wish to change the situation, you can work to avoid the stressor or alter the situation so it is not as stressful. And if you choose to change your reaction to the stressor, you can either adapt to it or accept it. Below are 25 healthy techniques and strategies that will help you change the stressful workplace situation or your reaction to it:

1. Create a peaceful space. Look objectively at your workspace. Are there books, files, and electronic media scattered everywhere, and are things stacking up? Is your bulletin board a mess of notes? Do you have to hunt to find what you need? Organize your workspace so that you have the space you need to work and so you can find what you’re looking for without knocking over your coffee cup. Make your workspace an oasis of calm and a place where you enjoy spending time.

2. Take a break. Yes, you’re busy. But you can always take a five-minute break to take a short walk, get a glass of water, or do some stretches and breathing exercises. If you work at a desk, try to leave it every two hours if only for a few minutes. The movement will help your circulation and give you the little break you need to refresh your body and your mind and cut down on stress. On occasion, we all work through our lunch hour. However, try to make this the exception and not the rule. Limit the amount of times you skip lunch or eat in a rush.

3. Break projects into small steps. If a large project seems overwhelming, make a step-by-step plan. Focus on one manageable step at a time rather than taking on everything at once.

4. Learn to transition from work to home life. When you walk out the office door, start to think about your family, your friends, or something you love to do. Refrain from working on days off or checking your work e-mail. You need downtime, so make sure you get it.

5. Meet challenges with humor. There is no better stress buster than a hardy laugh, and nothing reduces stress quicker in the workplace than mutually shared positive humor. Share a joke or funny story.

6. Resist perfectionism. No project, situation, or decision is ever perfect. You will put undue stress on yourself by trying to do everything perfectly. Be realistic in the goals you set for yourself. Just do your best.

7. Flip your negative thinking. If you look for the downside of every situation and interaction, you’ll surely find it. You’ll also find yourself drained of energy and motivation. Try to think positively about your work. Avoid negative-thinking co-workers. Pat yourself on the back about small accomplishments, even if no one else does.

8. Get moving. Regular exercise is an effective antianxiety treatment that lifts moods, increases energy, sharpens focus, and relaxes the mind and body.

9. Eat well. Fuel your body with healthy foods especially in times of increased stress. Say “no” to empty calories. Start your day with a nutritious breakfast. Reduce your sugar and caffeine intake. Well-nourished bodies are better prepared to cope with stress.

10. Learn relaxation skills. There are many relaxation skills including the use of music, meditation, diaphragmatic breathing exercises, aerobic exercise, muscle relaxation, and imagery. Many of these techniques can be self-learned through books, DVDs, and CDs.

11. Improve your communication and problem-solving skills. Learn how to speak about your own needs and wants and how to give positive and negative feedback to others. Speak up when the situation has become too stressful for you. Use your communication and problem-solving skills to discover viable strategies that will improve or eliminate stressful situations, especially those that are ongoing.

12. Get there early. Try to leave earlier in the morning. Even 10 to 15 minutes can make the difference between frantically rushing to your medical practice and having time to ease into your day. Don’t add to your stress levels by running late.

13. Learn to say “no.” Know your limits and stick to them. Refuse to accept added responsibilities when you’re close to your limit. Taking on more than you can handle is a great way to turn up the stress. Avoid scheduling things too tightly or trying to fit too much into one day. All too often, we underestimate how long things will take. Learn to be realistic in your planning.

14. Break bad habits. As you learn to manage your work - place stress and improve your work relationships, you’ll have more control over your ability to think clearly and act appropriately. You will be able to break habits that add to your stress at work. You’ll even be able to change negative ways of thinking about things that only add to your stress.

15. Talk it out. Sometimes the best stress reducer is simply sharing your stress with someone close to you. The act of talking it out and getting support and empathy from someone else is often an excellent way of blowing off steam and reducing stress. However, choose the person with whom you confide your stress very carefully. Don’t let things revert to an unproductive gripe session. And beware not to dump on anyone too often.

16. Cultivate work friendships. Just knowing you have co-workers who are willing to assist you in times of stress will reduce your stress level. Remember, though, that you must be willing to reciprocate and help them when they are in need.

17. Reframe problems. Try to view stressful situations from a more positive perspective. Look for the opportunity in every stressor.

18. Take responsibility. It’s up to you to improve your physical and emotional wellbeing. Avoid knee-jerk responses and negative attitudes that add to the stress you experience at work.

19. Avoid hot-button topics. If you get upset over discussions of religion or politics, cross it off your conversation list. Stop bringing it up or excuse yourself when it’s the topic of conversation.

20. Get enough sleep. Stress and worry can cause insomnia. However, lack of sleep leaves you more vulnerable to stress. When you’re sleep deprived, your ability to handle stress is compromised. When you’re well-rested, it’s much easier to keep your emotional balance, a key factor in coping with workplace stress. Go to bed early when you need to catch up on your rest.

21. Drink alcohol in moderation and avoid nicotine. Alcohol temporarily reduces anxiety and worry. However, too much alcohol can cause anxiety as it wears off. Drinking to relieve workplace stress can also start you on a path to alcohol abuse and dependence. Similarly, smoking when you’re feeling stressed and overwhelmed may seem calming. However, nicotine is a powerful stimulant that leads to higher and higher levels of anxiety.

22. Pare down your to-do list. Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.” Drop tasks that aren’t truly necessary for you to do to the bottom of the list, delegate them, or eliminate them entirely.

23. Block out the distractions. Depending upon your role in the medical office, you may find that stress can come from noisy co-workers, low-level open office noise, or other noises that interrupt your ability to concentrate and add to your stress level. Sometimes a polite reminder to colleagues that their private conversations can be heard is all it takes.

24. Limit interruptions. The phone rings. E-mails flood our inbox. On a good day, we can take it all in stride. However, when we have a deadline or are stressed for another reason, interruptions need to be limited. Use your voicemail to your advantage. Take calls that are a priority, and let the others go to voicemail. Set aside a more convenient time in your day for call-backs. Do the same for e-mail. You don’t need to answer every e-mail instantly. E-mail can eat a lot of your time and cause more stress. Schedule set times during the day to read and respond to your e-mails.

25. Create a balanced schedule. Analyze your schedule, responsibilities, and daily tasks. All work and no play is a recipe for burnout. Seek a balance between work and family life, social activities, solitary pursuits, daily responsibilities, and downtime. Plan something you enjoy to do every day.

Recent Statistics about Workplace Stress

Workplace stress has increased in recent years. For example, several studies1–4 suggest that:

• Twenty-five percent of working adults view their jobs as the top stressor in their lives.

• Seventy-five percent of employees believe that workers have more on-the-job stress than a generation ago. On average, employees work more today than they did 25 years ago, the equivalent of a 13th month every year.

• A particularly alarming cause of workplace stress (and part of a vicious circle as it also is a symptom of stress) is aggression or violence in the workplace. It is estimated that each year more than a million people are the victims of violence at work, accounting for about 15% of all violent crime in the United States. Aggressive behavior in the workplace ranges from the rare serious instances of physical assault to the more widespread passive forms of aggression such as withholding resources, not responding to phone calls and memos, and being late to meetings. When constantly repeated, these passive-aggressive behaviors result in psychological harm and loss of personal and organizational productivity.

• Problems at work are more strongly associated with health complaints than are any other life stressor, more so even than financial or family problems.

• Seventy-five percent of American workers describe their work as stressful.

• Forty percent of respondents in a recent survey described their work environment as similar to a real life survivor program.

• Workers who must take time off work because of stress, anxiety, or a related disorder will be off the job for about 20 days on average.

• Workplace stress costs U.S. employers an estimated $200 billion per year in absenteeism, lower productivity, staff turnover, workers’ compensation, medical insurance, and other stress-related expenses.

• Sixty percent of lost workdays each year can be attributed to stress.

• One-third of people surveyed considered quitting their jobs because of stress, and 15% actually did.

• According to the Holmes-Rahe Life Events Rating Scale,5 which rates the levels of stress caused by life events, many of the most stressful events are related to the workplace. These include firings, business readjustments, changes in financial status, altered responsibilities, a switch to a different line of work, trouble with the boss, variations in work hours or conditions, retirement, and vacations.

Sachs Hills/Handling Stress 221

REFERENCES

1. Maxon R. Stress in the workplace: a costly epidemic. FDU Magazine: The Magazine of Fairleigh Dickenson University. Summer 1999; www.fdu.edu/newspubs/magazine/99su/stress.html .

2. Nijmeh R. Workplace Stress: Tips for Coping with Stress. ACQYR. March 26, 2007; www.acqyr.com/stress/workplace-stress_tips-for-coping-with-stress-at-the-office_stress-article .

3. UPMC. Stress Coping: Stress in Today’s Workplace. The University of Pittsburgh Healthy Lifestyle Program. 2009; http://healthylifestyle.upmc.com/StressWorkplace.htm .

4. Webster T, Berman B. Occupational Stress: Counts and Rates. U.S. Department of Labor/Bureau of Labor Statistics. Fall 2009; www.bls.gov/opub/ted/2009/Oct/wk3/art03.htm .

5. Holmes TH, Rahe RH. Holmes-Rahe Social Readjustment Rating Scale. J Psychosom Res. 1967;11:213-218.

Article appeared in The Journal of Medical Practice Management