1. Stress Management Or
not

2. What Am I Going to Do? Big subject.
Think about what we mean by stress.
Think about why things stress us.
Look at some evidence about stress and doctors.
Suggest some ways of reducing its deleterious effects.
August 2001
Bruce Davies

3. What do we mean by stress?
Biological meaning
Social meanings
Medical meanings
Media meanings
Real or imaginary?
August 2001
Bruce Davies

4. New Problem or Old? Perceptions. “Modern life.”
Is war, poverty or crime stressful?
Stressors for me, stimulation for you.
Physiological endpoints are the same.
August 2001
Bruce Davies

5. Stress: problem or motivator
August 2001
Bruce Davies

6. Effects of Stress Physical. Mental. Social. Societal. August 2001
Bruce Davies

7. What Evidence Is There? More than you’d think.
Must remember all the “non-medical sources”.
What follows is a quick summary of the more important doctor specific research.
August 2001
Bruce Davies

8. Evidence Main stresses are.
The demands of the job,
Patient expectations,
Interference with family life,
Interruptions at work.
Work at home.
Dealing with administration.
May be substantial benefit in providing a counselling service for GPs.
C Cooper et al BMJ 1989; 298:
August 2001
Bruce Davies

9. Evidence
10 minute appointments put general practitioners under less stress when compared with the doctors' usual booking intervals of between 5 and 7.5minutes.
Stress can cause burnout or “rustout”.
It seems to be getting worse.
A Wilson et al BJGP 1991; 41: 184-7
TC O'Dowd JRCGP 1987; 37: 290
VJ Sutherland and CL Cooper BMJ 1992; 304: VJ Sutherland and CL Cooper BMJ 1992; 304:
August 2001
Bruce Davies

10. Evidence
GPs doing more paperwork at home then they and report more exhaustion or stress at the end of a working week.
R Chambers and J Belcher BJGP 1993; 43:
August 2001
Bruce Davies

11. Recognising Symptoms Physical signs. Emotional signs.
Behavioural signs.
August 2001
Bruce Davies

12. Taking Control Work pattern. Home / work. Work environment.
Managing time.
Routines of work.
August 2001
Bruce Davies

13. Expectations Cultural differences. Learning to say no.
Setting your standards.
The work play dichotomy.
August 2001
Bruce Davies

14. Exercise At work. At home. Learning to relax. Why does it help?
August 2001
Bruce Davies

15. Time Out Housekeeping. Gaps. DNAs Other work. Holidays. August 2001
Bruce Davies

16. Hobbies Outside interests. If medicine your life – do they matter?
Why helpful?
August 2001
Bruce Davies

17. Solutions ? T aking control E xpectations E xercise T ime out H obbies
August 2001
Bruce Davies

18. PROFESSIONAL BURNOUT D Kelly Update 15th June 1992 1163-1170
Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific
August 2001
Bruce Davies

19. Does Talking About It, and Studying It Make It Worse?
Stress Management
Does Talking About It, and Studying It Make It Worse?

20. Last Thoughts. Good trend: Unexpected bad thing:
Computers allow us to work
100% faster
Computers generate 300% more work.
Women get more political power.
Women are as dumb as men.
Music continues to get better.
I get old.
Bruce Davies

21. Thankyou
August 2001
Bruce Davies

22. MENTAL HEALTH, JOB SATISFACTION AND JOB STRESS AMONG GENERAL PRACTITIONERS
C Cooper et al BMJ 1989; 298:
Main stresses are the demands of the job, patient expectations, interference with family life, interruptions at work and home and dealing with administration. Concludes that there may be substantial benefit in providing a counselling service for GPs (and other health workers.)
August 2001
Bruce Davies

23. LONGER BOOKING INTERVALS IN GENERAL PRACTICE: EFFECTS ON DOCTORS' STRESS AND AROUSAL
A Wilson et al BJGP 1991; 41: 184-7
10 minute appointments put general practitioners under less stress when compared with the doctors' usual booking intervals of between 5 and 7.5minutes
August 2001
Bruce Davies

24. TO BURN OUT OR RUST OUT IN GENERAL PRACTICE?
TC O'Dowd JRCGP 1987; 37: 290
August 2001
Bruce Davies

25. VJ Sutherland and CL Cooper BMJ 1992; 304: 1545-8
JOB STRESS, SATISFACTION, AND MENTAL HEALTH AMONG GENERAL PRACTITIONERS BEFORE AND AFTER INTRODUCTION OF NEW CONTRACT
VJ Sutherland and CL Cooper BMJ 1992; 304:
Comparing 1987 with 1990, GPs experienced more stress from night calls, emergencies during surgery hours and interruption of family life by the telephone. Somatic anxiety and depression were both higher and job satisfaction had also decreased.
August 2001
Bruce Davies

26. PSYCHOLOGICAL STRESSES OF BEING A DOCTOR
P Whewell Update 1st June pp (references continued on p1071)
A review of the problems with some suggestions for coping and finding help.
August 2001
Bruce Davies

27. PROFESSIONAL BURNOUT D Kelly Update 15th June 1992 1163-1170
Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific
August 2001
Bruce Davies

28. R Chambers and J Belcher BJGP 1993; 43: 410-12
WORK PATTERNS OF GENERAL PRACTITIONERS BEFORE AND AFTER THE INTRODUCTION OF THE 1990 CONTRACT
R Chambers and J Belcher BJGP 1993; 43:
This paper indicates the changes resulted in GPs doing more paperwork at home and reporting exhaustion or stress at the end of a working week.
August 2001
Bruce Davies

29. STRESS, ANXIETY AND DEPRESSION IN HOSPITAL CONSULTANTS, GENERAL PRACTITIONERS, AND SENIOR HEALTH SERVICE MANAGERS
RP Caplan BMJ 1994; 309:
A worrying, but not surprising set of results. Action detectable anywhere? What interventions might work? What interventions have been shown to work?
August 2001
Bruce Davies