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How can a doctor cope with stress at work?
Yuri Domodedonenko
Galina Ivanova
Psychotherapist, Candidate of Medical Sciences, Associate Professor of the Department of Psychiatry, Narcology and Psychotherapy of the Faculty of Postgraduate Education of the Moscow State Medical University named after. A.I. Evdokimov.
The medical profession is traditionally one of the ten most stressful activities: it is associated with a sense of responsibility for the patient’s life, fear of making a mistake, tension and anxiety.
In normal times, high levels of fatigue, emotional exhaustion, and tension are noted by Psychological characteristics of doctors in a state of professional stress in up to a quarter of doctors, and in times of COVID-19, stress-related symptoms are identified Online mental health services in China during the COVID-19 outbreak already in 73% of medical workers.
Stress as a component of the life of a modern person
From a psychological point of view, a stressful state is defined as increased mental and physical tension in response to unfavorable environmental factors. It can be caused by injuries - physical and psychological, hunger, cold. The essence of the phenomenon is that in response to destabilizing stimuli, the body tries to adapt to environmental conditions, and certain processes - bodily and mental - become a side manifestation.
Stress has two fundamentally different forms - positive and negative, eustress and distress, respectively. Regardless of the type, its manifestations are similar.
In the modern world, where there are not only everyday dangers, but also environmental, man-made, terrorist and other threats, a person is in a state of stress for a significant part of his life.
Hidden Reasons
Uncertainty
The primary culprit of pre-exam stress is considered to be doubt about a sufficient level of knowledge. Writing test exams for the Unified State Examination, which are organized by the school or on a paid basis, will help you cope with such fear. It is advisable to conduct such a training test in advance, so that there is time to catch up on missed material.
Escalating the situation
Anxiety can be fueled by teachers, who in turn are under pressure from the administration so as not to lower the rating of the educational institution. The parents' task is to convince the student that even if he fails the exam, life will not be ruined. There is always a chance to retake or choose a different method of education.
"What I know is that I know nothing"
The saying of Socrates quite accurately characterizes the state of a student who is studying the material for the entire semester on the last night before the exam. Or the feelings of a schoolchild who, at the last moment, watches videos on YouTube “How to pass the Unified State Exam with 100 points.” The cause of stress in such a situation is the uneven distribution of the load.
Unfortunately, people have not yet learned to quickly absorb information. If you try to cram a large amount of knowledge into your head in a couple of days, your body will not be able to cope with such stress. To succeed in your exams, start preparing early.
Get rid of sources
It’s good when the psyche is initially stress-resistant, and the reaction to the stimulus does not cause destructive consequences. It’s great if an individual knows how to pull himself together and work on himself in a creative way. But what to do if a person cannot cope with the stress and depression that arises on his own? What to do when you don’t have the energy and time to delve into yourself and try to change something? The very first thing you can do is get rid of the irritant, or at least isolate yourself from it.
- If we are talking about the fact that communication with this or that person leads to a stressful state, such communication must be reduced to a minimum. No one can force you to see a hated mother-in-law, an annoying girlfriend, or a boyfriend who poisons your life. “I can’t do this, I can’t end this relationship, what it will look like from the outside, what people will say” - these questions should be the least of your worries when your own health is at stake.
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- Problems at work. Of course, quitting your job and looking for something new is not always possible. But this is not the only way out. You can always try to move to another department, or discuss with your superiors the delegation of part of the authority to another employee if you cannot cope with the volume of work.
- It happens that the climate of the region to which he moved is not suitable for a person. When traveling from a hot region to the North, many people actually note signs of stress, and not just discomfort. If you have a choice, you should not neglect the possibility of returning to more comfortable natural conditions, because constant stress from hypothermia, or exposure to the sun, high temperatures significantly affect your health.
By getting rid of the source of stress, a person may be accused by others of being weak-willed and unable to withstand circumstances. Let others think whatever they want. Your life and your health are only in your hands!
What causes stress and how does it manifest itself?
Stress is a nonspecific reaction of the body to extreme stimuli (stressors). For doctors, such extreme and often chronic irritants are contact with the suffering of patients, their death, intense workload, unstable work schedule, piles of paperwork, a feeling of legal insecurity, lack of support from management and colleagues, conflicts with patients and their relatives.
All these are “external” causes of stress, but there are also “internal” triggers based on a person’s system of values and aspirations, which are activated during a destructive collision of the doctor’s system of moral guidelines with a rough, harsh, unfair reality.
Then a high level of responsibility, perfectionism, dissatisfaction with one’s own social and financial situation, the experience of injustice or the inadmissibility of what is happening trigger a stress reaction.
For example, this is how dissatisfaction with the results of one’s work arises, associated with the influence of external factors: “I am a doctor, not a secretary, because of these papers of yours I have no time to treat,” “I brought my gastritis in a Mercedes, and he kicked the door open for me.”
For medical workers, professional stress makes itself felt through irritability, short temper, nervousness, anxiety, feelings of insecurity or helplessness, decreased mood up to depression, and sleep disturbances.
Problems with concentration often arise, memory and attention are impaired, interest in work disappears, and it becomes difficult to motivate yourself to do something important. Later, various psychosomatic disorders appear.
And then comes professional burnout - a state of emotional, physical and mental exhaustion in which the doctor can no longer perform his job with the same efficiency and does not feel satisfied with his own life.
Don't isolate yourself
The most important point when exposed to stress factors is communication with other people. There is no need to isolate yourself and be afraid to ask for help - medical, friendly, psychological.
- Parents, friends, colleagues - those around you can and want to help you. Sometimes they may not notice something themselves; there is no need to be shy about asking for advice.
- The advice of a psychologist, if we are talking about an experienced specialist, can bring a person out of a state of tension in just a few therapy sessions.
- The help of doctors of various specializations may be needed, because stress entails various bodily reactions. Painful conditions cannot be ignored.
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Sometimes a simple heart-to-heart conversation with people nearby can relieve emotional and psychological stress, significantly alleviating a person’s condition.
What does medicine offer?
On an individual basis, a neurologist can recommend medications that gently relieve stress and stimulate mental activity. Well-known remedies are valerian root and motherwort. If you start taking decoctions of these herbs in advance, they can reduce nervous excitability.
One caveat should be taken into account. It is necessary to take sedatives, including herbal infusions, in advance, since a noticeable effect will appear in a couple of weeks. It is extremely harmful to drink such remedies, including valerian, immediately before an exam. This can lead to undesirable consequences: loss of concentration and attentiveness.
Play some sports
Movement is life. A hackneyed phrase, a cliché, the meaning of which no one has been trying to understand for a long time. But in vain! The connection between psychological and physical state and physical activity is direct. During exercise, hormones are produced, which at the chemical level trigger recovery reactions in the body.
In addition to the immediate direct impact on the processes occurring in the body, physical education provides a distraction from daily worries, new interesting communication and a lot of positive emotions. And the changes in your figure that sports will certainly bring will become an additional incentive in life.
How to cope with family stress during quarantine
Due to the ongoing COVID-19 pandemic, more and more people around the world are stuck at home. One, two, three weeks. What's next? Steve Jordens, a professor of psychology at the University of Toronto, says stress during quarantine is inevitable, but it can be managed. We discuss how to cope with anxiety during isolation and support your mental health, especially when there are newborns and toddlers in the family.
— Professor, what problems do you think quarantine has brought to our lives?
- A lot of problems! At the core of our psyche is the need to predict possible scenarios. This gives every person the feeling that if he understands the world, then the world has meaning. But now no one can predict what will happen in the future. And this makes us feel anxious and dangerous. In response to what is happening in the body, a very primitive reaction is activated, which says: “When you feel in danger, do something!” Psychologists call it the “fight or flight” response. We would fight, but we don’t know how, and we have nowhere to run. The state orders to fight, but does not really explain anything. We end up energized but confused and scared. You can’t stay in this state for too long - however, the quarantine has dragged on and can last for a long time, and this makes it a little scary.
— Is it possible to identify vulnerable groups that suffer from isolation more than others?
“The situation has become truly difficult in families where there is domestic violence: the victim is now trapped with the abuser. It's likely that isolating people with anxiety disorders is also very different from isolating you. It's all very personal. There are people who have small children or 16-year-old teenagers at home, there are mothers, babies, pregnant women, and everyone’s situation is different. So we have to think about each of them.
— For many women, maternity leave becomes a long period of isolation. By the way, in Russia you can spend up to three years on maternity leave.
— I have two daughters who already have children of their own. When their first children were born, I was amazed at how many changes awaited them compared to life before the birth. It really is a kind of isolation.
“Despite this, some believe that in these difficult times, the daily routine of mothers has not changed. Do you agree with this? Is quarantine really an additional stress or, on the contrary, does the situation have its advantages in families with small children?
“This situation has the potential to become positive.” In the first weeks, everyone thinks: “How can everyone live in the same house, mind their own business?” You need to adapt to new conditions, and the initial stage of adaptation will be very difficult. We will continue to make mistakes, we will continue to bump into each other. Now our emotions are almost on the surface, and any disappointment very easily provokes a quarrel. But, despite all the difficulties, this can play a positive role in the future.
— What does this mean for parents who have to stay at home with their children?
“Once parents establish a routine and understand how to structure the daily learning process, there will be time to establish positive interactions with their children. Usually parents tell their children what to do and what not to do, that is, they discipline them. And now there is an opportunity to become someone who helps them learn, understand something new. And this will make adults feel good.
In my area, I often see parents with children, although I have never seen them walking together before. Maybe they'll enjoy it and do it more often after the lockdown is over. And then isolation will benefit them. So perhaps by the end of quarantine we will learn to live better.
For psychological health, it is important to know that the rays of the sun break through a black cloud - and those that still reach us should be especially appreciated.
- It turns out that you need to concentrate on something good, and not on irritation.
- Yes. And we must try our best to cope with this irritation. You will experience it. It doesn't mean there's anything wrong with your family just because you argue sometimes. This is probably more of the norm. And while we learn and try to find a way to avoid disappointment, we move towards a happy resolution of the situation. But we need time to get there.
— You mentioned that the “fight or flight” reaction mobilizes internal resources. Tell us a little about the basics of this phenomenon.
— A good example is stories about heroic mothers. A mom whose baby or small child is stuck under the car can easily lift it up to get her baby out. How can a woman lift a car if she usually doesn't have much strength? This is the fight or flight response.
If something happens to the child, the power that suddenly appears in the mother’s body comes literally out of nowhere. The heart beats faster, delivering oxygen to all muscles, there is a great desire to do something, and mom just lifts the car. These are the changes that the stress response is supposed to cause in the body. The body gives us almost superhuman strength so that we can run faster than we have ever run or lift weights we have never lifted. But there is a problem with this. In a stressful situation, we are not as good at thinking rationally because our body says, “Don’t think, do something.”
— Why might this become a problem in the current conditions?
— Modern threats are ambiguous, and this especially applies to COVID-19. Nobody knows when or how badly it will end. And our body reacts to what is happening in the same primitive way, as if it were something that we can simply grab, beat and solve the problem. But we can't. And this is precisely what creates an unhealthy situation of chronic activation of the nervous system - and subsequently the immune system suffers. Of course, during a pandemic, we do not want to reduce the body's ability to protect itself from infections. This is why thinking negative thoughts or making your body worry increases your risk of getting infected. You need to understand this and stop the running cycle, which is not so difficult to do.
— How to avoid additional stress?
— One of the analogies that I like to give is switching channels on TV. When trying to disconnect from the outside world, simply change the channel in your head. And then on TV. Because every time you watch the news, your brain gets a signal: “Hey, there's a threat out there,” which makes you more and more anxious. But you can watch other programs on TV that distract you. For example, gastronomic, music shows or something like that. And if you enjoy the program, use it as a way to distract your mind from worry. Whatever is occupying your mind - a book you like to read, a movie you like to watch - at that moment you are not thinking about COVID-19. Such activities are very powerful. And every time you find yourself in a state of stress or anxiety, you need to use them to distract yourself.
— Very good advice to prevent burnout in everyday life. But the problem is that “switching channels” in our minds is not so easy. How can a nursing mother survive the stress of quarantine, since stress and breastfeeding are hardly compatible?
- You can survive this. Sometimes postpartum depression is due to the fact that the mother somehow loses her self, who she was before the birth of the child. Let's say she was a professional in some field, and suddenly all this disappeared, now society perceives her only as a mother. Often the husband does not even understand how difficult it is to make the baby happy, because during the day he leaves home and is rarely left alone with the child. But if dad can take on some of the problems associated with raising and caring for the baby, the situation may not be so bad, since mom will feel that she is not alone, breastfeeding will improve and stress will fade into the background.
I think there is another problem associated with motherhood, which is especially acute in this situation. A mother's strongest instinct is to protect her child and take care of him. But she led him into a dangerous world in which there is an invisible enemy - a virus. Many people are afraid for themselves, and for a mother this fear can double, since she is also very worried about her baby.
The good news is that very few babies and children are affected by coronavirus.
And every mother needs to realize that her child is most likely fine. But it is still a dangerous world, and no one would want to bring a child into it with prior knowledge of the danger. However, unfortunately, this is the situation on the planet now. This is a very complex topic.
— Steve, what should you do if you can’t “collect yourself” and calm down?
— The best way to get rid of anxiety is to learn to relax, for example, through the process of controlled relaxation, as if removing stress from your body. You can lie down and clench your feet like fingers in a fist: as hard and dense as possible. Continue squeezing until the muscles ache, then squeeze a little more. And at the moment when the muscles reach a state of critical tension, they need to be relaxed. You will feel the tension literally leaving your legs. Then we move to the shins and repeat everything again, then we go up to the hips and move up the whole body to feel how the tension leaves it.
If you do this often enough, you can master what I call the “Jedi trick,” like in Star Wars, of pushing away tension. But it takes some time to learn this skill and requires a lot of training.
This exercise can be done with older children. They find him very funny. And if they master this skill, then during periods when something makes them feel bad, worry, maybe they will be able to say to themselves: “No, no, no. Relax and be rational."
— How to become “above” your emotions?
— I recommend choosing “your” word of power in case of stress. Mine is “beach” because it’s relaxing in itself. Imagine being told: “Why are you late for the third time this week? You are not a very good employee." It makes you feel stressed, tense, anxious. If you let your feelings take over, you might say something unpleasant. And then, after such a fight, you need to recover psychologically. Instead, as soon as you physically feel the tension rising, think: “Beach, beach, beach.” And the anxiety will begin to go away, and then, most likely, you will be able to give a reasonable reason for being late, and everything will be fine.
In a stressful situation, a rational rather than an emotional approach is more important.
Because we are rational beings: the emotional part of us is very primitive. And that's the part we're trying to control right now. It is emotions that force us to do something in the face of a threat, but we cannot allow them to take over our body. This is a skill that needs to be mastered.
— The “fight or flight” reaction makes you feel brave and strong, ready to fight, ready to object, but it can also provoke scandals or tension in the family if a person does not know how to control emotions.
“A person under stress does all this, and at the same time the frontal lobes of his brain turn off. There is strength, but he is no longer able to think rationally. This means that this power is used inappropriately, which causes trouble.
When stress activates the fight-or-flight response, a person may not feel good. And this is not courage, which allows you to consciously make decisions. Because at this moment people are worried about only one thing: should they fight or is it better to run? And we don't feel comfortable with this choice. Especially now, when we don’t know what to do with the coronavirus.
Therefore, we have strength and power that needs to be directed somewhere, but this is not a positive feeling. We feel trapped, unsafe, threatened. The condition is similar to when someone tells us something unpleasant and we experience strong emotions, but it is not positive. We don't become happy because of this. Rather, we say a bunch of things that we later regret. Therefore, when we feel that emotions are growing, we need to be able to say to ourselves: “Okay. No no no". Think of the situation as a dilemma: who controls your ship? Are you at the helm or does it float on its own? You need to know that you can climb to the helm and gain some control over the ship.
— You need to learn to manage your emotions in order to get out of stress.
- Yes. And you need to not only find and read tips on how to overcome stress, but also use this information to feel in control of the situation. If someone says you feel better when you watch comedy instead of the news, try it and see if you feel better. If you practice the things you learn and feel like they are working, you gain a sense of control. And that's really the basis. Then you feel psychologically calmer and become less of a victim of circumstances. And this is a very strong feeling.
— Without knowledge in the field of psychology, how can a pregnant woman or a woman who has recently given birth realize that due to constant stress she no longer has the strength, she is on the verge and needs to ask for help?
- If emotions run high in the home, stress and anxiety become too high. And the people who show the most emotion are the ones who need help the most. If domestic quarrels start, especially in families with small children in their presence, it’s time to do something. What? Ask family members for help or practice relaxation techniques. And if you haven't done this before, or have tried it once or twice and decided it doesn't work, you may need a friend or therapist to support you as a teacher and help you get back into practice. When you receive a task from someone, you take it seriously and spend time practicing. So I think anyone can handle stress with good guidance.
Techniques that each of us can practice in conditions of isolation from the social environment (social deprivation)
| Guided relaxation |
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| Communicate |
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| Get distracted |
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| Laugh |
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— Watching comedies and comedy shows is better than listening to the news now, right?
“We must use anything that distracts our attention from the cause that causes stress. It is important to reduce the amount of time watching news. Information is important and we should check it periodically, but we need to remain in control and decide when to turn on the news channel. For example, I will watch the news for half an hour at a specific time and after watching the news I will do something else to think about something else, to distract myself. I will still get the information, but I will do it on my terms. I control this stress factor because I know exactly what makes me nervous. So you are already fighting by staying at home. This is very important, especially for children.
Children need to know that we are not hiding from the virus, but protecting people in our community who are vulnerable to it.
When you stay home, the virus spreads less. And so we are trying to help doctors who are fighting it directly. This is an active action, despite the apparent passivity. We are fighting the virus, and children can feel involved in this important cause.
By the way, this is a good opportunity to talk about civic duty and show in practice how it can be fulfilled. For example, calling and talking to a person who may be alone in isolation, without modern technology to maintain contact with the outside world. You don’t have to talk for a long time: you can just check if everything is okay and ask how you are doing. And if you explain to your children that the other person needs attention right now and otherwise will feel really lonely, and communicating with them is a good thing, such an act will make your children feel good too. They realize that they are doing something useful, which is what everyone wants. So if a child understands that he is helping people and staying home to make the virus less harmful, he will know that he is doing something good. The more useful children feel, the better their mental health will be.
We usually come home from work, go to bed, and then the day starts all over again. We may not have thought, “What should I do with my children?” But now almost everyone has time for this. And these are bright moments of communication. From time to time, during quarantine and other difficult periods, you learn something that you would never have learned under other circumstances. And this is a reason to say: “Thank you, isolation.”
Professor, lecturer at the University of Toronto Scarborough and director of the Laboratory of Advanced Educational Technologies Steve Jordens
*The ideal food for an infant is mother's milk. WHO recommends exclusive breastfeeding for the first 6 months. MAMAKO® supports this recommendation. Before introducing new foods into your baby’s diet, consult a specialist.
Time to rest
Many people are so chasing money, career, recognition that they deny themselves rest. Just look at the common phrase “I’ll rest in the next world!” Jokes aside, relaxation is simply necessary for everyone.
Did you know that even slaves in ancient times were given one day of rest a week, and on holidays they had the right to rest along with their masters?
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In all world religions, the concept of a day off is separately stipulated; working on a holiday is sometimes considered a sin.
After all, even horses or pack donkeys are given time to rest!
Allow yourself to spend your time the way you want. Go on a visit, to a restaurant, to a disco, to karaoke, to go fishing on your day off. Perhaps the fatigue has already accumulated so much that you just need to go to hot countries and lie on the beach, or go to the mountains to ski. Don't drive yourself into a corner with continuous work, find time for weekends and vacations.
Reconsider your views
Even at school, children should be taught how important it is not to ossify their views and thinking. Sometimes we ourselves drive ourselves into stress, not seeing the world beyond our own blinders.
Expanding the horizons of your own consciousness, learning something, constantly learning and letting something new and interesting into your life is one of the effective ways to resist stress!
William James, a famous philosopher and psychologist, said: “A person can change his life by changing just his point of view.”
Communicate with people, meditate, read books - you need to do everything in order not to be conservative in your views. Being open to everything new, accepting with understanding even the negative realities of new times is the key to harmonizing your life, nervous system and physical health.
By regularly remembering the five simple rules described above, a person can not only get rid of an existing stressful condition, but also prevent it from happening in the future.
Who's at risk
Young people with high motivation are the first to be hit. Excellent students wishing to receive a gold medal, students dreaming of a diploma with honors and all those on whom Napoleonic plans are pinned. Even if such young men and women do not have to perform a feat during the exam, then there is something heroic in it.
People with increased emotionality who react sharply to unusual situations also run the risk of becoming victims of severe stress. If a child cried because of a D (or even a B) as a child, there is every chance that he will not be able to cope with exam stress on his own. To effectively cope with stress, it is important to set your priorities correctly. First of all, understand that mental health is more important than any prestigious university.
