Stress, burnout and balance

Introduction

student

Whilst most medical students are happy to have commenced a medical program and are looking forward to studying medicine and to eventually working as doctors, there is no doubt that it is also a stressful time. Juggling study, family life, personal interests and dealing with confronting clinical experiences can at times, be too much.

For many students commencing in the medical program has involved significant disruption and sacrifice. Moving house or even to a new country, leaving family and friends, resigning from responsible full-time work and becoming a student again. There may be significant financial stresses for students trying to juggle part time work and full-time study.

Are medical students and doctors different?

Research tells us that medical students come from a group that is likely to be hard working, self-sacrificing, somewhat obsessive and more comfortable when in control.

Of course, the problem is that people who are obsessive and perfectionistic are more at risk of depression and anxiety. We know from literature around the world that doctors suffer from the effects of depression, anxiety and stress related illness at higher rates than the general population. We need to recognise this in our selves and take steps to ensure that we don’t become overwhelmed.

Burnout in the medical field, as well as being personally debilitating (e.g. substance abuse, marital/family problems, stress related health problems), has also been linked to poorer "quality of care", leading to patient dissatisfaction and increased medical errors, and also poorer "quality of caring", where your ability to express empathy is reduced.

In this local study, 39% of graduating medical students reported high burnout rising to 75% mid way through internship year . Stress and burnout can, and do, occur early in training so it is important to try and address any issues sooner rather than later, as the way you learn to manage the stresses and challenges of the medical program may set up patterns that will continue for the rest of your career.

Managing stress


The medical profession does not have a good track record in acknowledging and managing stress and not all the coping strategies we utilise are constructive. This means that you have to take responsibility for yourself and be vigilant in monitoring your own stress levels and set up patterns of coping that will work for you throughout your career. Learn to recognise the ways that stress manifests itself for you – irritability, over-eating, stomach upsets, headaches, inability to concentrate and others. Ask your family and friends – they can probably tell you when you are stressed because it impacts on them too.

Concepts of stress, distress and impairment

We all experience stress. A little stress improves performance. When stressed is prolonged or unrelieved people become distressed and begin to have adverse effects including physical illness, altered mood, difficulty concentrating, irritability and insomnia to name only a few. Prolonged stress can lead both to inappropriate ways of coping such as drugs and alcohol and or psychiatric illness such as depression and anxiety.

Self monitoring for signs of stress

Your own body and people around you will tell you that you are stressed if you listen. Monitoring yourself for signs of stress such as insomnia, dyspepsia, gastrointestinal upsets, fatigue, irritability, headaches and others is a very important part of being a professional person. This is because high levels of stress affect your performance. Your family and friends will also tell you – if you are willing to listen – that your behaviour has changed.

If stress is unrelieved or you are becoming distressed – you need to ask for help.

Relaxing and de-stressing

Take some time to think about what which ways you relax. Some people relax by spending time alone reading, painting or playing music, some like a vigorous game of sport, some like to exercise, some like to talk or go out with to friends and family. Some ways of dealing with stress are likely to compound the problem – alcohol, recreational drug use, over-eating and many others. It’s worthwhile thinking about this and taking active steps to use constructive ways of coping. It’s very easy to slip into ways that are likely to harm you in the end.

Monitor your stress levels regularly and be prepared to seek additional support if stress becomes distress. Remember that you will be more effective in the end if you keep your stress levels under control, so stress relieving activities should be a priority, not something that you do only if you can fit it in. Staying fit and healthy should also be a priority both as a student and when you are a doctor.

Practising Mindfulness

Participation in a mindfulness program can also help reduce stress and burnout. This can be particularly useful if your self motivation to change is low, and a more structured approach, going once a week to a workshop with daily homework, is needed. Practising mindfulness can also lead you to more 'mindful practice' further down the track, where both you and your future patients get better care, a win-win all round (see this article for more).

Further information on Mindfulness Meditation Exercises.

Ask for help

Many medical students are reluctant to let anyone know if they are ill, stressed or distressed. Make sure you have access to people who can help – friends and family, a family doctor, a counsellor or psychologist. There are people in the medical program that can help – the Sub Deans for years 1 and 2 or the Clinical School Associate Deans and Sub Deans are a good place to start. The Student Support Website might give you some other options.