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  • the term “stress” was popularised in 1950's by Hans Selye, an Austrian-born Canadian physician. Prior to this the usual phrase used was “under strain”.
  • in engineering terms, strain is a measure of the extent to which a body is deformed when it is subjected to stress, while stress is the force exerted on a body that tends to cause it to deform.
  • in response to Selye, psychologists developed tables of what were asserted to be highly stressful events, such as death of a spouse, being sacked from a job, moving house, getting a divorce, etc.
  • everyone experiences stress, but of itself it does not cause emotional distress:
    • athletes inflict force upon themselves in order to change their form - they voluntarily subject themselves to stress with enthusiasm & commitment, in the expectation of improving performances - they call it training.
    • an environmental stress may generate emotional distress or it could be used as the challenge that strengthens us.
    • nevertheless, like athletes who over-train, excessive stress for our level of coping will tend to result in exhaustion, conflict, frustration, anxiety & depression.
    • extreme emotionally stressful events may lead to delayed post-traumatic stress syndrome in susceptible people.
    • how doctors manage stress is often dependent on their personality1)

red flags suggestive of burnout

  • Cognitive rigidity
  • Difficulty with ambiguity
  • Problems with setting boundaries
  • Inability to forgive oneself or blaming others
  • Irritability or sarcasm
  • Feeling of emotionally exhausted
  • A sense of depersonalisation (cynical and detached)
  • Muscle tension/headaches

stressors confronting ED doctors:

  • emotionally stressful patient situations (eg. death of a child)
  • pressure to work beyond your abilities
  • lack of support from senior staff or inpatient units
  • insufficient time to further develop your abilities
  • pressure to work when not physically well
  • lack of adequate staffing to cover sick leave
  • generalised job dissatisfaction & distress
  • lack of the expected rewards of appreciation and approval from peers, management and patients
  • imbalance between work, family life and fun
    • checking work emails when off duty increases stress and impairs sleep
  • inability to cope with work levels or poor patient care levels:
    • exit block - this is soul destroying as, regardless of clinical skill, you are unable to practice medicine to your own standards
    • persistent excessive patient workloads resulting in excessive waiting times & patient dissatisfaction
    • poor inpatient support - delay in having patients reviewed or admitted
    • inadequate facilities to deal with patient load or conditions
    • presence of poorly performing peers
    • inadequate change management
    • perception of inadequate support or abilities of management ED or hospital
  • anxieties related to:
    • ability to perform - risk of making judgement errors or procedural complications
    • risk of needlestick injury or exposure to other illnesses such as TB
    • risk of exam failure for those sitting exams
    • acceptance by peers
  • professional nihilism
    • for example the negative views on the current medical profession and the commodification of doctors - see here
  • existential crisis:

risk factors for psychiatric illness in Australian doctors

  • having a current medicolegal matter
  • not taking a holiday in the previous year
  • working long hours
  • type of specialty
  • having personality traits of neuroticism and introversion.
  • see 2)

risk factors for ethanol abuse in Australian doctors

  • male
  • being Australian-trained
  • being between 40 and 49 years of age
  • having personality traits of neuroticism and extroversion
  • failing to meet Continuing Medical Education requirements
  • being a solo practitioner
  • see 3)

other references and other resources:

psy_stress.txt · Last modified: 2017/07/17 05:50 by

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