Recognising and coping with stress

Be aware of the signs of stress and seek help early, advises Dr Mona Kular.

Doctors are not immune to stress. Quite the opposite, in fact. Evidence shows that in doctors prevalence of common mental disorders could be as high as 28 per cent compared with just 15 per cent in the general population.

It is usual to suffer from stress from time to time; however, when the pressures of stress exceed the person's ability to cope with it, problems can arise.

Stress and its causes
The human 'stress response' evolved to deal with immediate threats or dangers. We are not so well equipped to deal with the continuous barrage of stressors often encountered today.

Physiologically, a 'stressor' stimulates the release of adrenaline and noradrenaline, preparing the body for the 'fight or flight' response. Blood supply is diverted to relevant organs, such as the large muscles, while energy expenditure on non-essential processes, such as digestion, is reduced. Constant or repeated stimulation of this physiological response can eventually have a negative impact on psychological and physical functioning.

Certain people are more prone to stress. People with competitive or obsessive type-A personalities are often perfectionists who find it difficult to delegate tasks or decline extra work. Many of these personality features are found naturally within those in the medical profession.

Other common causes of stress for GPs include an increasing workload, frequent changes in policy and guidance, high patient expectations, conflicts in personal or professional relationships, lack of variety, disillusionment with the career choice and poor work-life balance. Working in isolation and long hours can also contribute to feelings of stress.

Signs of stress
Recognising the early signs of stress both in ourselves and our colleagues and taking measures to address the situation is extremely important.

Common signs of stress include decreased productivity, which may be due to poor timekeeping, missed deadlines, poor decisions making or even errors; a general fall in standards of work; and possible complaints from patients and/or colleagues. Other signs include emotional lability, increased irritation with colleagues or patients, and a general decrease in enthusiasm and motivation. There are also the possibilities of drug or alcohol misuse and prolonged periods of sick leave.

Burn-out is the end stage of excess stress, which may have been intense or prolonged. Four distinct stages often experienced prior to burn-out can be used as warning signs: overwork, frustration, resentment and finally depression with burn-out. Features of burn-out include emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment.

Significant numbers of GPs are affected by burn-out. A multifaceted approach can help deal with stress, and support services are available.

Dr Kular is a GP registrar in Nottingham.

Learning points

  1. How to prevent stress becoming an issue
  2. Be aware of the causes of stress, including those inherent to individual personalities.
  3. Learn to recognise the effects of stress early, both in yourself and colleagues.
  4. Adopt a multifaceted approach when dealing with stress.
  5. Address lifestyle factors that contribute to stress, including sleep, caffeine consumption and exercise.
  6. Challenge behavioural sources of stress, for example maintain a healthy work-life balance and learn to delegate tasks.
  7. Know where to turn for help if you feel unable to cope.

Dealing with stress

  • A multifaceted approach can help in dealing with stress
  • Sleep is vital to feeling alert, fresh and ready to deal with things. Try to get sufficient uninterrupted, sedative-free sleep.
  • Caffeine stimulates a 'stress response', causing reduced sleep, increased anxiety and depleted energy levels. Eliminate caffeine for three weeks to gauge the difference.
  • Exercise is a brilliant way of dissipating the pent-up energy and frustration caused by stress. Try to do at least half an hour of aerobic activity three times a week.
  • A good work-life balance is essential, and relaxation techniques such as yoga and meditation can be very effective.
  • Time management Feeling short of time can be a great stressor. Make lists prioritising your tasks with time scales in which they need to be completed. Setting realistic expectations, for example for the length of time it will take to travel to work in rush-hour traffic, makes life more predictable and manageable.
  • Delegate tasks that can be done by others, leaving yourself time to concentrate on the priorities. Learn to say 'no' to more work when you already have enough.
  • Core beliefs affect the way situations are interpreted. For example, thinking that the only way to get something done properly is to do it yourself will lead to poor delegation. This can be challenged by delegating tasks and finding your workload reduced.
  • Talking Getting things off your chest can relieve stress. If you are finding it difficult to cope, ask for help early on from a colleague or your mentor.

Useful contacts
BMA counselling line Telephone: 08459 200 169

Doctors' Support Network Telephone: 0870 321 0642

Doctors' Support Line Tel: 0870 765 0001.

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