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The Doctor Is In | Jul 2009

Stress Management for Surgeons: Part 1

Identifying tension levels.

This month's column is the first of a two-part series on stress management for surgeons. Physicians are typically comfortable dispensing tips to patients on managing stress, yet many of these same doctors push through long days without breaks, skip meals, don't get enough sleep, and then gulp as much caffeine as they can to keep up their frantic pace.


Why do so many of us fail to take our own advice? From a psychological standpoint, we quickly learned in medical school and residency training that working under chronically stressful conditions was not just something to survive but was also an achievement that separated us from those lacking the "right stuff." We learned to push ourselves physically, working 36 hours or more with little or no sleep (if you completed training before the work-hour restrictions that were instituted by the Accreditation Council for Graduate Medical Education). We worked even when ill rather than cause others to pick up our slack. As an intern, some of my residents on various surgery and medicine services (even psychiatry) would start off call nights with a "pregame" pep talk: "Remember, it's a sign of weakness to call for help. But if you absolutely can't handle it, then call." The overt message was clear; a good doctor should strive to handle most clinical issues independently. The underlying message was that stress, whether professional or personal, was something to be handled privately without impact on your performance or peers. I have found that physicians who fail to recognize or manage stress in their lives fall into two groups, the stress junkies and the stress strugglers.

Representing a fair proportion of surgeons, stress junkies proudly act as if the well-known negative effects of chronic stress on the human body simply do not apply to them. At conferences, they often try to outdo each other regarding who has the most demanding schedule, works the most hours in a day, or thrives on the least amount of sleep. Common statements they make include I thrive on stress; I love that adrenaline rush; I guess some surgeons can't handle it; but it keeps me at the top of my game; and I get bored if I try to relax. If these individuals exercise, they often use that time to ruminate about the future rather than to clear their minds. Unfortunately, left unmanaged, chronic stress catches up with most people by age 50.

This group's mantra is, "I know I'm stressed out. I know I need to exercise and take time to relax, but I'm struggling to keep up already." Mistakenly, they believe that making time for self-care will simply create more stress if they are already overscheduled. Instead, they keep pushing themselves, often feeling chronically fatigued and overwhelmed by their self-imposed expectations. These physicians may turn to alcohol or drugs to help them relax.

Physicians must learn to recognize and manage stress in their busy lives for their own mental and physical well-being. Moreover, those who maintain a balanced lifestyle serve as a role model for patients. Although I meet surgeons who are proactive about recognizing and reducing their external and internal stress, I meet many more who fail to do so. For the latter, the result is often problems with their health, relationships, and professional lives.

Next month, I will review some of the signs of unhealthy stress levels and discuss effective techniques for managing stress.

Jennifer S. Morse, MD, is in private practice as a consultant for medical and surgical psychiatry in San Diego. Dr. Morse may be reached at (619) 405-5919; www.the-doctor-is-in.com; jmorsemd@aol.com.

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