STRESS AND ANAESTHETIST

The previous night duty was so busy and i was tired out.The exploratory laparotomy went upto 2 am in the morning.Today i got up late and found my bus just leaving.My colleague staying next door offered me a lift but i reached hospital late.The morning ICU rounds already started and i tried to hide my self behind the team members, in order to escape notice of the consultant.The rounds finished and it was my turn to present the previous day's cases.It didnt go smooth as  I was drowsy  and was not able to concentrate. The consultant asked me to attend the elective  cases  in surgery OT where the list was also heavy with 3 major cases. While preparing for the cases, the  hospital clerk handed over  the university  notification for the venue and timings for final masters exam, scheduled  next month.The second case in my OT had a stormy recovery with laryngospam and agitation which was so difficult to control, and finally i am totally upset when the school principal telephoned and conveyed the message that my daughter is sick and will be brought to OPD.

Stress can be defined as mental, emotional or physical strain or tension which is an integral part of everyone's life.Even though moderate stress is necessary for the optimal function of human beings undue stress may have physiological and psychological impact(1) Stress occurs when there is a perceived imbalance between the demands being made and the ability to meet those demands.It is a pattern of strain produced by excessive urgency or pressure.  According to Cooper  stress is negatively perceived quality which could cause physical and mental ill health.

Most of the doctors are found to have Type A personality featuring insecurity of status and a high amount of anxiety. This personality type is often associated with increased aggression and a constant sense of time urgency and mental tension.They are more prone for stress related responses.They also tend to have a higher incidence of coronary artery disease and may have problems coping with and responding to difficult situations. This may lead on to psychiatric problems in the future.


In the specialty of anaesthesia it is now well recognised that anaesthetists do suffer from stress. In a recent survey (4) 30% of anaesthetists felt stressed a lot of the time while 5% felt stressed all the time; 33% described themselves as severely stressed and 7% felt their stress was more than severe. In the work related environment the stressful elements were lack of control (42%), strained professional relationships (25%), work overload (24%), difficult work (6%) and potential litigation (3%). In the area of administrative and social factors, administrative responsibilities (42%) and work-home conflict (35%) were the most stressful while money (14%), teaching responsibilities (6%) and peer review (4 %), were less so.
Responses to excessive stress are categorised as;
 Behavioural Response:

• incrased irritability
• destructive behaviour
• obscessive compulsive disorder
• increase in substance abuse ,(easy availability of drugs for anaesthetists) smoking, or alcoholism

Physical Response

• Hypertension
• Loss of weight
• Sleep disturbance

Personal Response

• Intellectual impairment
• Poor concentration memory and judgement

According to one survey( 3) the consequences of stress are found to be

• Difficulty in sleeping 70%
• loss of libido 40%
• Physical illness 35%
• Incresed alcohol intake 35%
• Contemplated suicide 21%
• Drug misuse 4%

Some of the sources of stress as far as Anaesthesiologists are concerned are

• Difficulty to cope with work pattern including irregular working hours and emergency work
• Frequent CME programs
• Sleep deprivation
• Bad professional relationship with colleagues
• Family problems
• Chronic illness
• Unstable employment
• Time pressure
• Fear of Litigation, eventhough, 'Anesthesia' today is considered to be more safe.

Stress Management Strategies:

• Modifying response to stress:Developing self esteem; Identify your strength and weakness.Realise the concept that something can be changed but something cannot be.So better change yourself and adjust.
• Developing coping strategies, try to develop existing ones and implement new strategies.
• Developing communication skills. Effective communication is in fact a best reliever of stress.They help to avoid misunderstandings and help to allay anxiety and fear.
• Time management effective time management strategies identify goals, set priorities, and manage time.
• Improve professional and personal relationships.
• Hobbies; indulging in favourite hobbies, achieve balance between work exercise relaxation and personal development.
• Attending stress relieving workshops,accident and incident conferences, in which anaesthetists present the critical situations they encountered, could also help.They play a role in the social and emotional support to be given to the stressed.
• Improving social support in the professional setting,by maintaining personal relationship
• The simulator, which is increasingly used for crisis-management training, can be of some help in the management of stress for those who have excessive response to it.

                                      Recreational activities and gathering help to reduce stress.
 
 
Other measures

• Positive thinking, the ability to degree or disagree or say yes or no without overt hostility whenever appropriate
• Avoidance of stressful situation by logical thinking. Don't try to manage a problem which could have been avoided.
• Avoid isolation, develop friendship, join 'facebook' and add me as friend
• Keep your knowledge updated. Follow Mary Ann's Journal watch http://www.anaesthesiacases.com.au/ regularly.
• Maintaining good health, regular exercise, nutritious and timely diet, regular sleep pattern, Meditation etc.

One recent study( 4) among anaesthesiologists has shown that the mean stress level was 50.6 which is no higher than we found in other working populations. The three main sources of stress reported were a lack of control over time management, work planning and risks. About 40.4% of the study group were suffering from high emotional exhaustion (burnout); the highest rate was in young trainees under 30 years of age.

SUMMARY OF REPORT ON STRESS BY AAGBI ( Ref.1)

• A stressed doctor is not necessarily a bad doctor but difficulties may occur  when the stress gets out of control.
• The multiplicity of support groups attests to the fact that problems are widespread and solutions complex.
• The organisational difficulties in the workplace lead to an inability to reach desired goals and produce frustration. It is clear that lack of control and the problems of administrative responsibilities figure most highly as stressful factors.
• Consultants are responsible for each other by moral obligation and for trainees and non consultant grades by convention. In stressful situations discussions with a friendly, understanding colleague may be all that is required to resolve difficulties. 
• The skills of stress management are integral to the management of many conditions at work and in everyday life.
• Communication skills are basic in our personal and professional lives and the ability to stand up for one’s rights without violating the rights
  of others is important in the practice of assertiveness. It is necessary
  to learn to say no, when appropriate, in a constructive and non confro ntational manner and there is need to be able, politely, to resist
  unrealistic demands from others. Some distorted beliefs may be longstanding and encouraged by our environment.
• When problems occur the first action of the Clinical Director must be
  to discuss the situation with the person involved or to get another senior colleague to do so. Any reported problems should be approached with diplomacy and confidentiality must be respected.However documentation, statements and witnesses are also important.It must always be remem bered  that patient safety is paramount.
• At any stage in a consultant career support and advice may be needed.It is not widely understood how the various support systems work. All directorates should practise their methodology of dealing with problems  and of providing support for colleagues. A mentor system may be worthy of exploration.
• All doctors should be discouraged from self diagnosis and, especially,self treatment.
• Support and treatment should always be on a confidential basis

For those in UK and Ireland ,The Association of Anaesthetists of Great Britain and Ireland can provide confidential guidance in all these matters
Ref (1)   STRESS IN ANAESTHETISTS
The Association of Anaesthetists of Great Britain and Ireland,
9 Bedford Square, London WC1B 3RA, UK.
Telephone 0171 631 1650; Fax 0171 631 4352;
E-mail: aagbi@compuserve.com
       (2) Wylie Churchil Davidson, A practise of Anaesthesia; 7th edition.
       (3)coulson J, Stress in doctors, BMA News Review 1996; April 24,
       (4) A. S.Nyssen, I.Hansez, P.Baele, M.Lamy and V.De Keyser; Occupati onal stress and burnout in anaesthesia; British Journal of Anaesthesia, 2003, Vol. 90, No. 3 333-337