Rethinking Stress in Medicine

Several years ago, a typical work day for me would start off with waking up by the alarm clock, thinking that I did not want to go to work. I was convinced that it would be a long day and certain patients would be draining my energy by asking me many questions or making unrealistic requests. That was enough to drain even more of my energy. It was especially challenging to live through another day of spending an extra three to four hours after seeing the last patient to finish all my work.

Operating with tension was challenging. My muscles were always tense. There were these permanent knots on my shoulders. My resting heart rate was bordering on the fast side – probably because my mind was not really resting.

That state of feeling worried was contagious, not just for other people but also within myself. I was feeling stressed about my workload and work hours. Somehow more situations popped up in my mind which caused me to feel more stressed – what to make for dinner, there was no time for me to spend the extra time to do that mandatory training, just as examples. Before you know it, everything I was thinking or experiencing seemed to be causing stress.

As much as I did not want to feel stressed, I was constantly, not by choice, reminding myself of how stressed I was feeling. It had become a habit to have that not-so-little voice in my head to tell myself that this was my life as a physician. I would feel stress all the time – deal with it.

The dealing part was not the best way to cope with the mental tension I was experiencing. No, I did not attempt any illegal or hazardous habits, but there were some not-so-healthy behaviors. That stressed out feeling was unpleasant. In my body, it felt like a gathered, irregular ball of unpleasant energy that was moving randomly from place to place because it could not settle down. The uneasy feeling would intensify from time to time during work. When I paid attention to it, I had a hard time focusing. If I tried to ignore it, that stress seemed to intensify and haunt me more.

I did not like that feeling at all. I did not want to feel stressed, or at least not at the level of intensity I was always experiencing.

Then one day, I learned that feeling stressed was optional. What? It certainly did not feel like that for the longest time. The key to understanding your stress is to know and understand yourself.

When you feel stressed, acknowledge it. It is not helpful to convince yourself that, in this situation, you should not be feeling stressed. “Should-ing” yourself is not going to decrease your stress level. Once you acknowledge that you are stressed, face it with kindness instead of judgment. Then explore the reason behind your stress. It is not your situation, but your opinion about the situation that is causing you to feel stressed. For example, your work situation is that you have 30 patients to see that day. Your opinion may be that there are too many patients to see – possibly because your usual average number of patients is 20.

It is not helpful to focus on how an alternative reality should have taken place. We cannot rewind time. We do not have control in everything, but we can control how we approach and react to any situation. You can choose to feel worried. You can choose to feel overwhelmed. You can choose to accept the situation and focus on what you can do about it.

Once I realized that we have control of what and how we think, and that our thoughts determine our emotions, I allow myself to be open to think of the same situation in different ways, then choose one perspective that is helpful. This is liberating because it is not the situation that causes us to feel a certain way; it is our opinion on a particular situation that leads us to have a certain emotion.

I do not remember where I first heard this – stress is optional. Since then, I have adopted it and shared it. We do not always have a choice of our circumstances, yet we always have a choice of how we think. This realization itself has decreased much of my stress.

Stress can affect us physically and emotionally. Feeling stressed can cause us to do things we may regret – I am not talking about the extreme cases of harming someone or doing something illegal. For example, when you feel stressed, you ignore your work and watch TV instead. Or you binge eat. Or do compulsive shopping. Then you find yourself regretting your behavior, followed by feeling even more stressed because you wasted your time and energy to do something that was not helpful.

Besides acknowledging that you feel stressed, identify what you are thinking that is causing you to feel that way. If you are stuck and not sure what to do, talk to someone about it. Or take a break, walk away for a bit, spend some time in nature. Give yourself a few minutes to quiet your mind and meditate. Phone a friend – not necessarily for advice but for someone to talk to.

As part of the human experience, we are always going to face situations which we may believe are stressful. Believing that there will be no more stress is not realistic. It is important to allow ourselves to experience all our emotions, pleasant and unpleasant ones. Know ourselves and acknowledge our feelings. Be open to possibilities of different perspectives and different management options.