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Spotting the signs of stress

A health professional affected by stress explains how GPs can recognise and address the signs and symptoms at an early enough stage to avoid burnout.

Stressed or burnt out people will overestimate the problems they face, underestimate their ability to cope with them, and create even greater worries in their heads (Photograph: Istock)
Stressed or burnt out people will overestimate the problems they face, underestimate their ability to cope with them, and create even greater worries in their heads (Photograph: Istock)

'Physician heal thyself.' Although not its original meaning, this proverb alludes to the tendency of doctors to focus on healing others, while neglecting their own health.

There are many reasons why doctors are so reluctant to seek help, but fear and shame of admitting to a need for help can sometimes seem overwhelming. The isolation that this can lead to can be the catalyst for increased stress levels and eventual burnout.

Burnout does not happen overnight. It builds up over weeks, months and sometimes even years, but it can be halted by making some minor changes to one's thinking and behaviour.

Everyone is different

Everybody responds differently to the world around them. What one person finds stimulating and encouraging, another might find unbearably stressful.

This comparison between colleagues can often be the trigger for the onset of stress, with one assuming that others are coping well, while you are struggling to keep your head above water. These feeling of inadequacy, failure and shame often serve as the very reason why one might avoid addressing the issues before it takes hold, for fear that we will be rejected, ridiculed or viewed as weak.

To make matters worse, the ways one might think and behave when stressed often make the problem appear even greater. Typically, stressed or burnt out people will overestimate the problems they face, underestimate their ability to cope with them, and create even greater worries in their heads. They will perceive themselves to be failing, and often think that they are beyond help.

These thoughts may lead one to withdraw both mentally and physically from the things they once enjoyed, and increased engagement in self-damaging behaviours in an attempt to terminate their feelings.

A recent BMJ study based on interviews with 500 GPs found that 46% of GPs showed some of the above signs and symptoms, so if these things sound familiar, you are not alone.

How to spot the early signs

The first sign of increased stress and burnout is an effect on sleep (either too much or too little). This can be accompanied by frequent headaches, tiredness, changes in appetite, bowel problems and changes in sexual appetite or function. Individuals or their partners might notice that they have become easily irritable or aggressive.

More subtly, sufferers may notice difficulty concentrating and more of a tendency to procrastinate over decisions, or avoid big decisions at all costs.

  • Address the early signs and symptoms as quickly as possible.
  • Writing down worries before bed, or keeping a list of important tasks, may help you look at things more objectively.
  • Make time to learn how to relax. Try to find what works for you.
  • Increasing activity can help - try to build this into your daily routine.
  • Eat more healthily and drink less alcohol.
  • CBT can be particularly helpful in dealing with stress.

What to do

It is important that these signs and symptoms are addressed as quickly as possible. If picked up early, very simple changes can have great effects.

Small and simple actions, such as writing our worries down before we go to sleep at night, or keeping a list of important tasks, can help us see problems more realistically.

When problems are written down, we're more likely to view them objectively, instead of them gaining momentum as they swirl around our mind.

Making time to learn to relax is also important. There is no 'one size fits all' solution to relaxation, but investing time in learning what works for you will pay dividends in the future. Yoga, mindfulness or deep breathing works for some, while squash, boxing or taekwondo works for others.

Increasing your activity level in any way possible will also help. Small modifications to your routine, such as walking to work instead of driving or taking the stairs instead of the lift, will all help. Building increased activity into your daily routine will mean it takes less time and effort.

Eating more healthily and drinking less alcohol will also help to lift one's mood. The fact that you are reading this probably means you are a GP and already know this, but sometimes reminders help.

Consider the advice that you would give a patient in this situation - then let yourself be the patient, not the doctor, and take your own advice.

If you have already tried these things and you are still feeling stressed and burnt out, it might be time to seek help. Your own GP is the starting point, but a range of other support is also available (see the Practitioner Health Programme website at www.php.nhs.uk).

Talking therapies

Antidepressant medications may be an option but there are also a variety of different talking therapies to suit your preference, the most common and effective being CBT.

CBT is grounded in the present and while it does not ignore the past, it focuses on current problems and seeks to identify and modify any unhelpful thinking and behaviour.

By gently challenging long-held beliefs, participants can learn the inherent faults in their thinking and behavioural responses and, with the guidance of the therapist, change these to more adaptive, useful ways of thinking and behaving.

One of the biggest hurdles to seeking help is often the beliefs people have created, and the conclusions they have drawn about what might happen as a result of admitting to a need for help.

The fear and shame that people might experience as a result of admitting they need help is often a symptom of the burnout, rather than an objective and realistic appraisal of the current situation.

  • This article was jointly written by a practitioner patient who wishes to remain anonymous and Richard Jones, specialist nurse at the Practitioner Health Programme (PHP), a free, confidential service for doctors and dentists in London. www.php.nhs.uk

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