Stress among healthcare workers: Physician, heal thyself!!

Healthcare is a stressful profession and takes a toll at physical, emotional, and mental levels. Dr Aparna Ramakrishnan, Consultant Psychiatry, Kokilaben Dhirubhai Ambani Hospital Mumbai talks about the strategies to reduce harmful effects of stress and prevent it from spiralling out of control in the future

The only constant in Life is CHANGE. But another constant that has emerged in these recent, turbulent times is STRESS.

STRESS is a state where demands of the situation exceed the (personal and social) resources the individual is able to mobilise. Perceived pressure is more than the perceived capability. Moderate levels of stress or EUSTRESS can be beneficial. It improves our focus, efficiency and performance and gives a sense of achievement and satisfaction when goals are set and met. However excessive stress can negatively impact an individual’s health and productivity.

Healthcare is a stressful profession and takes a toll at physical, emotional, and mental levels. Studies have shown that nearly 25-60 per cent physicians report exhaustion across various specialities. An Indian study (Grover et al 2018)  conducted among medical faculty and resident students has shown that perceived stress and depression (30 per cent) is higher in medical professionals with 16.6 per cent reported severe risk of burnout.

Besides the stressors faced by the one and all, individuals working in the healthcare sector face a multitude of stressors that are unique to the profession itself.

• Constant state of responsibility for the lives of others and critical decision making where mistakes or errors could be costly and sometimes irreversible.
• Entry into medical education is an expensive and strenuous task .Training at both the undergraduate and postgraduate levels is long and tedious.
• Work overload, excessive working hours, sleep deprivation, repeated exposure to emotionally charged situations, dealing with difficult patients, dealing with patient loss, and conflicts with other staff.
• Peer pressure within and across the profession with remunerations, social acceptability and recognition not being commensurate
• In addition work related stress, maintaining a work life balance is like walking a tightrope for health care professionals. Lack of adequate balance leads to poor social life, interpersonal issues and family based stress.
• Society perceives doctors as affluent individuals who are expected to maintain a certain lifestyle and yet are supposed to perform only acts of service. Failure to meet these can be an additional source of stress.
• Inadequate infrastructure and equipment, hostile job environment, administrative and bureaucratic bottlenecks can lead to job frustration.
• Fear of litigation, assaults, unsecured future, delays in promotion, lack of adequate breaks/holidays and inappropriate capacity utilisation can lead to a lack of fulfilment

Stress creates a personal cost to the individuals, a financial cost to the organisations in terms of absence, early retirement and complaints, and a health cost to patients in terms of the risk of poorer quality care that is received by patients from stressed or dissatisfied staff. Medical professionals especially doctors are at increased risk for divorce and suicide. Gender specific differences have also emerged with higher stress in women.

Stress is a risk factor for a multitude of physical and emotional disorders. Burnout and compassion fatigue are some of the serious consequences of long term stress along with depression, anxiety disorders, sleep disorders, substance use disorders and sexual dysfunctions.

The COVID-19 global pandemic, a health care crisis further exacerbated the already high levels of stress for the health care workers. Disrupted workflows, heavier workloads, time restraints to care for their patents , additional work hours, fear of contracting the disease and passing it to their loved ones and death of co-workers and patients were the additional troubles that had to be faced and overcome .

However there are simple, practical and effective strategies for stress management. Stress management is NOT the absence of stress. Stress management is taking charge of your lifestyle, thoughts, emotions, and the way you respond to stress. There is no one-size-fits-all. It involves learning and practising healthy coping strategies to reduce harmful effects of stress and prevent it from spiralling out of control in the future

It includes:

• SELF CARE-PHYSICAL: Take good care of your physical health via well balanced diet and adequate exercise, avoid or decreasing substance use
• Challenge your own unhelpful thoughts and beliefs (eg catastrophising, negative assumptions, punitive self-labelling) which lead to negative and unhelpful emotions and behaviour worsening the stress. Increase rational self-talk and remember that “THOUGHTS are NOT FACTS”.
• Learn to adapt , think of situations from a different perspective, learn to look at the bigger picture
• Set reasonable standards for yourself and others (NOT PERFECT, BUT GOOD ENOUGH)
• Be assertive yet calm and courteous while communicating. Set appropriate limits and boundaries for yourself and others.
• Accept that some situations and peoples behaviours aren’t under your control. However your responses certainly are. Don’t React-RESPOND
• Look at the brighter side of things, always keep a sense of humour. Have an attitude of gratitude
• SELF CARE-EMOTIONAL: Learn from your mistakes but don’t keep beating yourself over them. To err is human. Practice kindness, compassion and love towards yourself.
• Develop and maintain good support systems at work and in life. Ask for help when you feel overwhelmed
• Practice prioritisation and time management. Schedule time for hobbies, rest and relaxation too.
• Practice relaxation techniques like diaphragmatic breathing, yoga, meditation and mindfulness

Accept things as they are and move forward with a smile. Most importantly, remember you can’t pour from an empty cup. Practice what you preach. A healthy happy health professional can provide the best help to a patient on his road to recovery.