2. Stress Management Or not

3. August 2001Bruce Davies2 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.

4. August 2001Bruce Davies3 What do we mean by stress? Biological meaning Social meanings Medical meanings Media meanings Real or imaginary?

5. August 2001Bruce Davies4 New Problem or Old? Perceptions. Modern life. Is war, poverty or crime stressful? Stressors for me, stimulation for you. Physiological endpoints are the same.

6. August 2001Bruce Davies5 Stress: problem or motivator

7. August 2001Bruce Davies6 Effects of Stress Physical. Mental. Social. Societal.

8. August 2001Bruce Davies7 What Evidence Is There? More than youd think. Must remember all the non-medical sources. What follows is a quick summary of the more important doctor specific research.

9. August 2001Bruce Davies8 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.

10. August 2001Bruce Davies9 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.

11. August 2001Bruce Davies10 Evidence GPs doing more paperwork at home then they and report more exhaustion or stress at the end of a working week.

12. August 2001Bruce Davies11 Recognising Symptoms Physical signs. Emotional signs. Behavioural signs.

13. August 2001Bruce Davies12 Taking Control Work pattern. Home / work. Work environment. Managing time. Routines of work.

14. August 2001Bruce Davies13 Expectations Cultural differences. Learning to say no. Setting your standards. The work play dichotomy.

15. August 2001Bruce Davies14 Exercise At work. At home. Learning to relax. Why does it help?

16. August 2001Bruce Davies15 Time Out Housekeeping. Gaps. DNAs Other work. Holidays.

17. August 2001Bruce Davies16 Hobbies Outside interests. If medicine your life – do they matter? Why helpful?

18. August 2001Bruce Davies17 Solutions ? T aking control E xpectations E xercise T ime out H obbies

19. August 2001Bruce Davies18 PROFESSIONAL BURNOUT D Kelly Update 15th June 1992 1163-1170 Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific

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

21. August 2001Bruce Davies20 Last Thoughts. Good trend:Unexpected bad thing: Computers allow us to work 100% faster Women get more political power. Music continues to get better. Computers generate 300% more work. Women are as dumb as men. I get old.

22. August 2001Bruce Davies21 Thankyou

23. August 2001Bruce Davies22 MENTAL HEALTH, JOB SATISFACTION AND JOB STRESS AMONG GENERAL PRACTITIONERS C Cooper et al BMJ 1989; 298: 366-70 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.)

24. August 2001Bruce Davies23 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

25. August 2001Bruce Davies24 TO BURN OUT OR RUST OUT IN GENERAL PRACTICE? TC O'Dowd JRCGP 1987; 37: 290

26. August 2001Bruce Davies25 JOB STRESS, SATISFACTION, AND MENTAL HEALTH AMONG GENERAL PRACTITIONERS BEFORE AND AFTER INTRODUCTION OF NEW CONTRACT VJ Sutherland and CL Cooper BMJ 1992; 304: 1545-8 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.

27. August 2001Bruce Davies26 PSYCHOLOGICAL STRESSES OF BEING A DOCTOR P Whewell Update 1st June 1992 pp1003-4 (references continued on p1071) A review of the problems with some suggestions for coping and finding help.

28. August 2001Bruce Davies27 PROFESSIONAL BURNOUT D Kelly Update 15th June 1992 1163-1170 Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific

29. August 2001Bruce Davies28 WORK PATTERNS OF GENERAL PRACTITIONERS BEFORE AND AFTER THE INTRODUCTION OF THE 1990 CONTRACT R Chambers and J Belcher BJGP 1993; 43: 410-12 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.

30. August 2001Bruce Davies29 STRESS, ANXIETY AND DEPRESSION IN HOSPITAL CONSULTANTS, GENERAL PRACTITIONERS, AND SENIOR HEALTH SERVICE MANAGERS RP Caplan BMJ 1994; 309: 1261-3 A worrying, but not surprising set of results. Action detectable anywhere? What interventions might work? What interventions have been shown to work?