The Stress Factor

Working as a junior doctor gives a new meaning to the word stress. Sara Williams explores how to keep it at bay.

Last May Janet Street Porter wrote an article headlined “Depression? It’s just the new trendy illness!” She went on to write: “Get a grip girls!” – describing depression and stress as the “latest must-have” accessories for middle-class women. Her article was met with much criticism; Alistair Campbell described her opinion as “misguided” and “offensive” and Mail columnist Allison Pearson said that at least depression is manageable, unlike Janet Street Porter.

Such unsympathetic advice on handling stress demonstrates that there are still some negative mainstream attitudes of stress and depression. Stress is a real and modern illness. According to the Health and Safety Executive (HSE), 11.4 million working days were lost in 2008/09 to stress, depression and anxiety.

Everyone suffers from some pressure in their lives: it can be a good thing, motivating us to get our work done and raising performance; however, when demands and pressures become excessive, they can lead to stress. The HSE defines stress as:

“The adverse reaction people have to excessive pressures or other types of demand placed on them at work.”

How common is stress among junior doctors? Hospitals are challenging places, full of demanding individuals, who openly question the staff that work in them. In the face of this, junior doctors must maintain calm, well-presented and attentive demeanor, while multi-tasking in a frenetic environment.

The BMA’s Doctors for Doctors support service takes more than 2,000 calls a year for doctors. This service was set up by Dr Mike Peters. He says doctors most commonly contact the advice line about:

• Career issues
• Bullying/racial harassment
• Issues with staff/partners
• Complaints procedures
• Feelings of exploitation
• Co-existant health problem/stress
• Psychological support
• Inappropriate relationships with staff and patients
• Work/life balance
• Burn out

Dr Peters says: “Most calls are about career issues. This is because when doctors have a health problem, suffer from stress or burnout, or are going through a complaint or litigation, this is often a time for them to reflect on their career specialty and whether they should change or indeed leave medicine – so they contact us.”

How to deal with stress

If you are feeling stressed or finding it difficult to cope, it is important to get help early. Not being aware of the depth of your feelings could lead to escalating problems, such as depression or drug and alcohol dependency.

Dr Peters encourages junior doctors to call Doctors for Doctors when they feel stressed out: “We are not here for treatment or diagnosis; we are an entry level for a doctor who is having difficulty coping. We offer a reflective space to discuss problems with a colleague or a professional counsellor 24/7.”

Tips on managing stress:

• Put boundaries up – learn to say no
• Take time out – particularly when you start to feel stress
• Keep a stress diary – to identify what things are creating stress
• Acknowledge limitations
• Get a good GP – see them when you are not well and listen to their advice
• Hold regular meetings – we’re all human: working at the “coal face” leaves little time for this, so organise time for reflection with colleagues
• Be open – say you’re stressed

Coping with stress in the long term

Dr Fiona Donnelly is the chairman of the Doctors Support Network, a peer support group for doctors. Dr Donnelly says the online forum she runs receives 2,500 posts each month. The 24-hour community discuss problems and how to deal with them. Many posts come from A&E medics, psychiatrists and GPs: Dr Donnelly says this is because they are exposed to more mental illness, so it is less stigmatised.

“I got involved in this group because I experienced stress and depression in my own life. It was brought on by a series of events that occurred in a short period of time. I got married, bought my first house, started my first psychiatry post doing the job of a higher level trainee as my consultant was off sick, and then I was assaulted by a patient.

“I left my illness for a very long time. I had no idea how ill I was. I felt very guilty, as there was a perception that people made things like this up to get out of work. I could do the job fine, but when I got home I wouldn’t leave the sofa or speak to my husband.”

Dr Donnelly says that it is vital that staff are aware of the signs of stress in their fellow employees. Her illness would have been diagnosed sooner if she’d had better support around her.

“How effective stress management is depends on the local culture of where someone is working: some areas take a hard line on illness, and offer support and encourage staff to take time off. However, I know of other areas where the attitude is old fashioned – if you can’t take the stress you shouldn’t be doing the job.

Dr Donnelly was an inpatient for six months and afterwards went back to work. Despite a few relapses, she has moved on and taken hold of her life again, working as an SPR in psychiatry and bringing up two children. She attributes her success to sharing her feelings and supporting others through Doctors Support Network.

Working as a junior doctor can be one of the most stressful periods of your career, but if stress is effectively managed and the avenues to support services are well signposted and explored, stress can be managed, to the benefit of both staff and patients.