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   Table of Contents      
REVIEW ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 2  |  Page : 22-25

Stress and the medical practitioner


Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Date of Web Publication6-Sep-2017

Correspondence Address:
Yvonne Dabota Buowari
Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJGP.NJGP_13_17

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  Abstract 


Stress is a complex phenomenon difficult to define but occurs every day and medical practitioners are not left out. There are many sources of stress for medical doctors including hectic work schedule, lack of sleep and food because of calls and emergencies and these give rise to adverse effects on the health of the doctor who is to care for the health of the populace. This is a review article after searching different online search engines including PubMed, Google and other literature on the topic and studies carried on stress at the workplace especially how it affects medical doctors. There is need to incorporate stress management programs amongst doctors to prevent burnout and medical errors which can lead to litigation.

Keywords: Doctors, effects, health care, stress


How to cite this article:
Buowari YD. Stress and the medical practitioner. Niger J Gen Pract 2017;15:22-5

How to cite this URL:
Buowari YD. Stress and the medical practitioner. Niger J Gen Pract [serial online] 2017 [cited 2017 Nov 18];15:22-5. Available from: http://www.njgp.org/text.asp?2017/15/2/22/214110




  Introduction Top


Stress is a universal and inevitable component of life, and hence, some degree of stress is not harmful.[1],[2],[3] The term stress, as it relates to human experiences, has been in the scientific literature since the 1930s.[4] Stress is found in all aspects of our lives; it seems particularly overwhelming in the job or the workplace. It is a subjective experience, as what challenging for one person would be a stressor for another; it depends largely on background, experiences, temperament, and environmental conditions.[5]

The World Health Organization has viewed stress as a global epidemic as stress has recently been observed to be associated with 90% of visits to physicians.[6] Medical and dental schools are known to be highly demanding and stressful learning environments.[7] Medical education poses many new challenging and potentially threatening situational demands for students around the world.[8] Stress is a part of everyday life for health professionals such as nurses, physicians, and hospital administrators, as their main responsibility focuses upon providing help to patients who are usually encountering life crises.[9]

Medical doctors often go through some stress related to their profession while carrying out their duties.[10],[11] Several studies have shown that there is a higher level of stress among doctors as compared to the general population.[11] Rates of stress are elevated in all doctors, regardless of the setting in which they work, but junior and female doctors are particularly at risk.[11] The stress among doctors is increased during the residency program as confirmed in a Nigerian study, in which 50% of the residents who have been studied reported that most of their lives had been stressful,[12],[13] as what appears to be stressful to one person may be a welcoming challenge or all in a day's work for someone else. Being a doctor is emotionally and physically demanding,[11] though some stress help to increase our alertness and energy to meet challenging situations. Stress has become a more recognized term over the past decade. Medical education is inherently stressful and demanding.[14] The Association of Anaesthetists of Great Britain and Ireland published a document on stress on anesthetists.


  What is Stress? Top


Stress is viewed as the psychological reaction that occurs when people perceive an imbalance between the level of demand placed upon them and their capability to meet those demands.[15] Stress is defined as a harmful condition, resulting from the inability of the organism to maintain an adequate internal equilibrium.[16] Stress is a wear-and-tear process experienced by the mind and body as an attempt to cope with the environment that is changing continually when the pressure is greater than the resources.

Stress is the body's physical and emotional reaction to circumstances or events that frighten, irritate, confuse, endanger, or excite us and place demands on the body. In general, stress is a pressure exerted on something that can damage or make it lose its shape[4],[8],[11],[17],[18],[19],[20] The stress reaction is seen as an individual response to a given stress, which can be behavioral, perceptual, physiological, emotional, and cognitive, or signs and symptoms of illness or disorders, such as headaches, alcohol abuse, obesity, cardiovascular disease, and hypertension.[4],[21] The health and safety executive defines stress as the change in mood or behavior, deteriorating relationships with work colleagues, being late to work and absenteeism, frequent complaints, and reduced performance indicating unhealthy levels of stress in an individual.[21],[22] Stress is a response to disequilibrating stimuli as encountered in the social environment. In the stress response perspective, discerning the nature and importance of these stressors is important to understanding and diagnosing stress, and develop strategies to deal with its potentially deleterious physiological and psychological effects.[9] Stress is a natural human response to pressure when faced with challenging and sometimes dangerous situations. The pressure is not only about what's happening around us, but often also about demands that we place on ourselves. Stress can be defined as comprising of the environmental factors which exert undue strain or pressure on a person and can be caused by numerous factors either at home or in the workplace. Stress is difficult to define.[18] It has elements of physical, mental, or emotional strain. Stress can be defined as a physical or psychological stimulus, which can produce mental tension or physiological reactions that may lead to illness.[6] Stress can mean different things to different people.[22] Stress is a subjective phenomenon and an anxiety-based syndrome, which manifests differently in different persons and hence, the lack of a stereotyped definition.[19]


  Occupational Stress Top


Job stress is recognized as a chronic problem.[23] Workplace stress is the harmful physical and emotional responses that can occur when there is a conflict between job demand on the employee and the control an employee has in meeting these demands.[24] Some jobs are intrinsically more stressful than others.[25] Hospital work involves some of the most stressful situations found in any workplace. Stress at and outside of work could contribute to the morbidities experienced by the healthcare staff.[25] It is believed and expected that the medical doctor must be in a perfect state of mind devoid of worries and anxieties.[20] However, job stress among healthcare staff is becoming a common occurrence in most public healthcare services.[26] It is an important issue in the workplace, not only because it affects the doctors' health, but also because it impairs the quality of health service that the doctors are expected to deliver.[27]

Stress in the workplace is often referred to as occupational stress.[9] The basic rationale underpinning the concept is that the work situation has certain demands and that problem in meeting these can lead to illness or psychological distress. The healthcare industry being very sensitive in nature must manage the work-related stress of doctors to achieve the objective of service to society.[21]


  Sources of Stress to the Medical Doctor Top


The sources of stress in medical practitioners vary with the type of medical practice (private versus public, hospital-based versus community-based) and specialty.[11] There are many potential sources of stress related to the job, the organization, the doctor himself/herself, work–life balance, and relationships with other people.

Some sources of stress for medical practitioners are as follows:

  1. High patient load[1],[9],[11],[17],[29]
  2. Highly demanding patients[1]
  3. Occupational risks such as needlestick injuries[1]
  4. Imbalance between effort and reward[1]
  5. Time pressure[11],[17]
  6. Administrative duties[11],[17],[28]
  7. Sleep deprivation, especially during calls[11],[28]
  8. Irregular meals
  9. Threat of malpractice suits
  10. Poor work environment
  11. High demands on self and others[11],[26]
  12. Dealing with the dead and dying[11],[26]
  13. Confrontation with emotional and physical suffering
  14. Staff conflicts[9],[11]
  15. Bullying and harassment from patients, patient relatives, colleagues, and other health workers
  16. Over spillage of stress from work to home and vice versa[11],[26]
  17. Balancing between work and family commitment.[26]



  Stress Management at the Workplace Top


Dealing more effectively with stress improves performance and the quality of life. All efforts should be made to convert all stresses into eustresses. This can be achieved by stress-management techniques. Adverse effects of stress may affect not only the individual doctor but also his/her family life, marriage, and social life.

Stress management refers to the strategies of coping, recovering, reinterpreting, refraining, and cognitive restructuring adopted by an individual who is under stress, making changes that can reduce stress, or taking actions that alter stress.[4],[21],[29] The employer needs to pay attention on stress factors at the workplace. Balancing work and life through time management is highly essential to reduce stress.[21] The stress management program will help to reduce the stress, create job effectiveness, and have a good work–life balance.[4]

Doctors can help themselves in reducing the impact of stress and avoiding burnout or other morbidity by the following ways:[11]

  1. Identify the most important sources of stress
  2. Time management enhances the doctors' sense of control, increased productivity, reduced overload and strain, and reduces anxiety
  3. Avoid exhaustion, get enough rest, take a break from time to time, engage in a leisure activity, exercise regularly, and have a healthy diet
  4. Protect the job, manage workload, focus on aspects of the job that gives satisfaction, delegate where necessary, and say no when it cannot be done
  5. Maintain a good work–life balance
  6. Do not expect perfection
  7. Learn relaxation techniques
  8. The causes of stress are to be identified, and actions should be taken to eliminate it
  9. The length of the working hours should be minimized
  10. Presence of senior doctors while dealing with critical patients is helpful in reducing the stress level among junior doctors
  11. Holidays are refreshing and should be taken at least once a year
  12. Stress can either be managed or reduced this as it cannot be totally eliminated from the life of an adult human being.


Changes at the workplace that are necessary for stress management in doctors[18]

  1. Establish a physical health committee
  2. Mentoring program
  3. Confidential support groups
  4. Annual well-being retreat
  5. Membership to fitness clubs
  6. Continuous medical education on topics related to well-being
  7. Flexible schedules
  8. Decrease paperwork.



  Conclusion Top


The quality of work and work-life is maintained when people have a stress-free life at the work place. High stress feelings in doctors are due to longer working hours, which results from a high patient volume and leads to stress. Some of the sources of stress to the medical practitioners are from family relationships and occupation. Stress impacts the overall health of the doctors, leading to insurance costs, decreased productivity levels, absenteeism, and low morale. Stress is a complex phenomenon, and there are various definitions for it. Stress occurs when the body is required to perform beyond its normal range of capabilities. Although stress can hardly be eliminated, a proper way of coping with stress can be practiced to reduce stress.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflict of interest.



 
  References Top

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Aslam HD, Jamil R, Tariq A. Stress in medical practitioners in private healthcare industry. Asian Soc Sci 2014;10:111-6.  Back to cited text no. 1
    
2.
Joseph TD. Work related stress. Eur J Bus Soc Sci 2013;1:73-80.  Back to cited text no. 2
    
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Wahab AB. Stress management among artisans in construction industry in Nigeria. Glob J Res Eng 2010;10:93-103.  Back to cited text no. 4
    
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Jain A, Bansal R. Stress among medical and dental students: A global issue. J Dental Med Sci 2012;1:5-7.  Back to cited text no. 7
    
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Sani M, Mahfouz MS, Bani I, Alsomily AH, Alagi D, Alsomily NY, et al. Prevalence of stress among medical students in Jizan university, Kingdom of Saudi Arabia. Gulf Med J 2012;1:19-25.  Back to cited text no. 8
    
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Alnems A, Aboads F, Al-Yousef M, Al-Yateem N, Abotabar N. Nurses Perceived Job Related Stress and Job Satisfaction in Amman Private Hospital; 2005. Available from: http://www.citeseerx.ist.psu. [Last assessed on 2016 Oct].  Back to cited text no. 9
    
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Agucha GU, Onyeama GM, Bakare MO, Igwe MN. Prevalence of depression among resident doctors in a teaching hospital, South East Nigeria. Int J Clin Psychiatry 2015;3:1-5.  Back to cited text no. 12
    
13.
Ogunsemi OO, Alebiosu OC, Shorunmu OT. A survey of perceived stress, intimidation, harassment and wellbeing of resident doctors in a Nigerian teaching hospital 2010;13:183-6.  Back to cited text no. 13
    
14.
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[PUBMED]    
15.
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16.
Onifade OA. The causes and prevalence of stress among civil servants in Kwara State. Niger J Physical Health Educ Recreat 2002;2:20-5.  Back to cited text no. 16
    
17.
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Solberg KK. Stress and coping for today's physician; 2008.  Back to cited text no. 18
    
19.
Babohope IS. Causes and effects of job related stress among polytechnic librarians in Delta State, Nigeria. Int J Lib Sci 2013;2:1-5.  Back to cited text no. 19
    
20.
Brunero S, Cowan D, Grochulski A, Garvey A. Stress Management for Nurses. SW Health. Sydney: New South Wales Nurses Association; 2006. p. 8-11. Available from: http://www.nswnurses.asn.au.  Back to cited text no. 20
    
21.
Arya M, Barloda S. Occupational stress among doctors: A case study of Pt B.D. Sharma University of Health Science Rohtak. Int J Multidiscip Res 2012;2:321-8.  Back to cited text no. 21
    
22.
Murray R. Managing your stress, a guide for nurses. Royal College of Nursing Working Well Initiative, London; 2005. Available from: http://www.rcn.org.uk. [Last assessed on 2016].  Back to cited text no. 22
    
23.
Thian JHM, Kannusamy P, Klainin-Yobas P. Stress positive effectively and work engagement among nurses: An integrative literature review. Singapore Nurs J 2013;40:24-33.  Back to cited text no. 23
    
24.
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25.
Ntaji MI, Okhakhu AI, Bamidele JO. Job satisfaction and stress among medical practitioners in Edo State, Nigeria. Niger Res J Clin Sci 2011;1:27-33.  Back to cited text no. 25
    
26.
Loo-See B, Leap-Hon L. Job stress and coping mechanisms among nursing staff in public health services. Int J Acad Res Bus Soc Sci 2012;2:131-76.  Back to cited text no. 26
    
27.
Psychological morbidity and sources of job stress among doctors in Yemen. ASEAN J Psychiatry 2012;12.  Back to cited text no. 27
    
28.
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29.
Moustaka E, Theodoros CC. Sources and effects of work-related stress in nursing. Health Sci J 2010;4:210-6. Available from: http://www.hsj.gr. [Last assessed on 2016 Oct].  Back to cited text no. 29
    




 

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  In this article
Abstract
Introduction
What is Stress?
Occupational Stress
Sources of Stres...
Stress Managemen...
Conclusion
References

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