Stress! Addressing The Unseen Foe…


STRESS!! Addressing the elephant in the corridors, the exam rooms, and in the mirror.

As physicians we are no strangers to stress- learning to perform under pressure is part of the package. But in “perfecting” this skill, could we be losing sight of the real impact of stress in our lives and in the lives of our patients? The changes in healthcare are about to make our patients mental well-being more critical to our revenue. And if we don’t make our own mental well-being more of a priority we cannot reverse the alarming numbers (40%!) of physicians who would choose to leave practice if they could!

Early in my career I was always fascinated by the fact that patients with essentially the same clinical picture could be experiencing their diseases in such a wide range of ways—from profound misery to cheerful acceptance to even apparent vitality of spirit in the face of death. What made one person focus on the suffering and another on hope, possibility or gratitude? Clearly, those who were not handling the stress of life well were less resilient in the face of medical challenges. (I was also bemused by the arbitrary separation of physical and mental health—as if putting the diagnoses in separate books and under separate insurance codes teased apart the intricacies of human experience?!)

Equally apparent were the varied reactions of fellow clinicians under the strain of ridiculous hours and whopping mental and physical demands. The very mechanism of the stress reaction reduces blood supply to the frontal lobe, that part of the brain responsible for self-awareness. (Thus explaining the “What was I thinking” phenomenon!)

To make matters worse, many high achievers train themselves to further ignore the signals and alarms of the stress reaction. Sadly this leads to higher risk for costly mistakes, career or personal dissatisfaction, burnout, relationship and health problems. We have all witnessed the burnout of far too many excellent, caring doctors. When coaching physicians, I often find we need to work on down-regulating the stress, before we can effectively address leadership or career strategies.

I spent 10 years studying brain mapping (qEEG), various forms of biofeedback, and the mechanics of behavior. I had the opportunity to see first-hand how simply changing thoughts minute to minute radically alters our physiology and our brain activity. I found that patients with high perceived stress scores had a much harder time learning new patterns of behavior, or fighting the depression or health decline of extended cortisol overload.

Stress—our reaction to the perception that our homeostasis or safety has been threatened, or that we do not have the skills or energy to meet the challenge—has been estimated to be somehow involved with 70-90% of all doctors visits! Yet we barely have time to review labs and adjust meds, much less ask questions that might open a can of worms about dealing with the complicating factors of real life. We were not taught to empower our patients to handle stress—we weren’t taught healthy ways to handle it ourselves!

To be effective in addressing the role of stress we need a better model to develop the language to help our patients and ourselves. (Our brains love models!) The term “stress” is so overused and misunderstood that many myths have taken root.

The job of our brains is to filter out the billions of bits of information it receives moment to moment searching for anything that might be a threat to us. That identification process (mostly amygdala based) is dependent on our perception—our genetics, stories, experiences, and current psycho-physiological state.

Once the alarm is sounded the mostly sympathetic reaction involves some 1400 chemical reactions—a very energy intensive process! This is a one-sized-fits-all reaction designed to protect early man from chasing wildebeests. But there has been no software upgrade to help us deal with constant onslaught of annoying emails, EMR challenges, technology breakdowns, or interrupted sleep. The chronic ringing of the alarm bell depletes the energy balance of every physiological and psychological system.

We know this—the research is overwhelming and our experience lives it—but we need to find ways to clearly and succinctly discuss this with our patients and proactively step up our own stress management. In this model there are 3 entry points to change the balance:

• Proactively reducing the exposure to internal and external stressors (seeing this as proactive choosing how to spend our precious time and energy.)
• Reframing our perspective to sound the alarm less often—acceptance, mindfulness, attitude work.
• Raising our resilience by increasing the habits that support our fitness—physically, mentally, emotionally, and spiritually.

I find this way of looking at stress empowers patients and professionals to see they have choices that will increase their energy, their confidence, and their personal accountability to take an active role in their health, performance, and overall well-being. By choosing to balance the energy we spend with thoughts, behaviors, and practices that renew our energy, we can make the subtle shifts that take the bite out of stress.

What small change can you make today that will find you more energy, more ease? How can you help your patients take a more active role in their stress management and well-being?

Please let me know if I can help. It’s a big topic, but critical to medical outcomes and happy doctors.