Managing Stress- the importance of self care.

Facts.

1. The professional networks you use for your patients may not be right for your own health care.

3. The health system relies heavily on caring health professionals giving that bit ‘extra’.

4. Medicine ,Nursing and Allied health are tremendously fulfilling careers .

5. We need to be well to do them!!

When health is absent ,

wisdom cannot reveal itself ,

art cannot become manifest,

strength cannot fight ,

wealth becomes useless and

intelligence cannot be applied.

Herophilus , ancient Greek physician

The Medical Culture

• Competitiveness vs collegiality• Confidentiality• Doctors as patients• Doctors who treat other doctors• Self-treatment• OH & S Issues

What Stresses Doctors???

• Keeping to time• On-call• De-skilling • Practice Management• Balancing work and home life• Family fragmentation• Partnership issues• Demanding patients• Clinical incidents

More Stressful Situations…

• Career issues for spouse

• Issues surrounding education of children

• Overwork and tiredness / high patient doctor ratios

• Physical illness• Death of young patients• Missed diagnosis• Treating

“patient/friends”

• Medical exams while working

• Increased accountability to government

• Paper work • Threat of litigation• Decreased time with

patients • Unfulfilled ambitions

Even more stressful stuff…• Medical catastrophes• Financial stress• Relationship difficulties• Emotional isolation• Coping with non-medical

presentations• Local hospital issues /

administration

• Lack of anonymity in small towns

• Managing threats, stalking, affectionate patients etc

• Lack of opportunity to de-brief after critical incidents

• Poor Time management skills• Poor Stress management skills

Student Stressors• Time management . Financial/ personal problems . Academic burden SUBSEQUENT STRESSORS

. Learning to talk to patients/clients . Relationships with senior clinicians . Perceived humiliation by seniors . Longer working hours . Difficult workload . Fear of errors and/or litigation . Career disappointment . Shift work - sleep deprivation . Upsetting clinical experiencesDON’T TAKE BAD COPING HABITS INTO LATER LIFE!!

Effects of stress

• Hyper vigilance• Anxiety• Depression• Working harder and poor time management• Irritability• Withdrawal and poor stress management• Dismissiveness• Sudden departure• Uncharacteristic behaviour• Alcohol

P.S. Listen to what others tell you!

Depression

• Low Self Esteem• Helplessness• Hopelessness• Withdrawal• Being Overwhelmed• Sadness• Guilt• Not Coping

• Feeling devalued• Powerlessness• Blaming Government• No contact with non

Patients and non family

• Procrastinating• Trying to work Harder

Barriers to self-care

• Feeling you can treat yourself and deal with it alone.

• Not recognising you are sick.

• Self-diagnosing.• Embarrassment of

showing any weakness to colleagues.

• Reluctance to access local help.

• Confidentiality.• Own referral networks not

appropriate.• Fear of Medical Board.• Insurance issues.• Poor knowledge of stress

management.• Duty of care to patients

overrides all.• Lack of a medical

advisor/advocate.

The time to relax is when you don’t have time for it !

Edward De Bono

Your support networks..

• Personal– Non- medical friends– Other Professionals– Sporting friends– Other Parents

• Professional– Your Own Doctor–  Lawyer–  Accountant–  Personal Trainer / Coach–  Dentist–  Psychologists

•  Family•  Medical

– student colleagues–  within your Practice–  within GP Divisions–  NZMA–  Mentors

• Other–  Clubs –  Baby sitters/ cleaners–  Neighbours 

Getting the balance isn’t easy

Family

Spending

Self Help

De-skilling

Work

Earning

Helping Others

Complex patients

Quick Quiz!

YES NO Have you had a check up in the last 2 years? 1 0 Do you have in existence a Personal Medical Record? 1 0 Do you exercise 4 days week? 1 0 Do you have your own GP? 1 0 Do you eat regular healthy meals? 1 0 Do you drink more than 2–4 glasses of alcohol a day? 0 1 Do you smoke? 0 1 Do you know what your cholesterol is? 1 0 Do you know what your blood pressure is? 1 0 Do you get sufficient sleep? 1 0 Do you know your family history? 1 0 Do you meditate or practice a relaxation technique ? 1 0 SCORE..12 great..10 good..8 fair..6 poor..4 poorer..2 IVT?..0 CPR!!

The Energy Flows

PROFESSIONAL

• Work demands• Business

Management• Time pressures• System stressors• Medicolegal

• Deskilling• Computerisation

The things that drain you…

The things that drain you….

PHYSICAL

• Poor diet• Inadequate sleep• Lack of fitness• Inadequate exercise• Dehydration• Poor posture• Weight – too much, too little

The things that drain you…..

PERSONAL

• No free time• Sickness• Isolation• Dysfunctional

relationship• Family

fragmentation

FINANCIAL

• Inadequate rewards• Excess spending• Debt• Taxation

The things that drain you…..

MENTAL

• Anxiety, depression• Sleep disturbance• Conflicts with

partners, family• Unresolved conflicts

or problems

CHEMICAL

• Caffeine• Alcohol• Cigarettes

What do I do.…?????

Now for some solutions!!!

ENDORPHINS released by;

• Exercise• Crying• Laughter• Singing• Music• Sex• Meditation• Pain

The Power of the spring clean

RE- ARRANGE

RE- FRESH

RE- DISCOVER

RE- LINQUISH

RE- NEW

RE- NAME

RE- PRESENT

RE- ITERATE

RE- FLECT

RE- NOVATE

RE- INVENT

RE- LOCATE

RE- EVALUATE

RE- VISIT

RE- LAX

Time for a make-over?REFRESH Your ideas, approaches, attitudes Your environment Your wardrobe Your appearance

REINVIGORATE Yourself physically and spiritually

REDISCOVER Discarded hobbies, interests Ambitions, loves Your creativity Non-medical books

RENEW Old friendships Your faith Previous interests

REARRANGE Your room Your study Your car

REITERATE What is important to you Your ambitions

REFLECT On your blessings What sort of person you are What has worked well for you What you have given up for medicine

RESCHEDULE Your 24 hour day

RECONNECT With family With supportive friends With mentors With your spirituality With music With humour

What you can derive strength from……

PHYSICAL

• Competitive sport• Exercise• Adequate sleep• Good posture• Breathing correctly• Adequate fluids• Sex

What you can derive strength from….

MENTAL

• Yoga• Meditation• Music• Laughter• Crying• Creativity

What you can derive strength from….

SPIRITUAL

• Religion• Nature• Solitude in the

bush

DIETARY

• 3 regular meals• Good food mix• Antioxidants

What you can derive strength from..

SOCIAL

• Friends in medicine• Interests outside medicine • Friends outside medicine• Team mates• Arts/culture• Clubs• Travel• School

PERSONAL

• Your relationship• Family• Free time to reflect• Your Patients

What you can derive strength from….

PROFESSIONAL• CME• Upskilling• Retraining• Projects• Research• Associations• Mentors

FORWARD PLANNING

• Your work• Your roles• Your holidays• Using a DIARY

What you can derive strength from…..

ENVIRONMENTAL

• Fresh air• Sunlight• Good chair and desk• Low pollution

What you can derive strength from….

INTELLECTUAL

• Hobbies• Music• Conversation• Non medical interests

• One of the symptoms of an approaching nervous breakdown is the belief that one’s work is so terribly important that to take a holiday would bring all kinds of disaster!!

Bertrand Russell

TIPS

• Eat well and regularly• Exercise regularly• Mobilise endorphins often• Practise effective time management• Develop personal and professional supports• Rediscover neglected interests• Recognise your early warning signs of stress and

SEEK HELP• Have a Crisis Plan for when you are not well• Discuss your health with your GP• Don’t ignore signs of distress in a colleague

Benefits of having your own GP

1. Establishment of a Personal Medical Record

2. Confidential, non judgemental advisor

3. Comprehensive, holistic continuous care

4. Treatment for any problem

5. Your well-connected advocate in health system

6. Recall systems in place

7. Phone advice and availability

8. A caring person interested in you

9. A trusted confidante

Choosing your CAREER in HEALTH may challenge these areas of your life……….

• Relationships• Religious and moral beliefs• Health• Hobbies / Talents• Successful parenting• Friendships• Family Contact• Other career opportunities BUT……..

Positives of a career in health!

• Strong demand for your services• Many employment choices• Long working life• Work is valued and respected • World–wide opportunities• Splendid peer group• Work flexibility• Character-building experiences• Meet many people with amazing life stories

!!

“We can only help people from a position of strength”