Guest Post: How to manage stress and anxiety as a hospital doctor

Our guest blogger, Dr. Caroline Walker, is a full-time Doctor’s Wellbeing Specialist, a Psychiatrist and Therapist for NHS Practitioner Health and Founder of The Joyful Doctor, a not-for-profit organisation dedicated to improving the wellbeing of caring professionals through coaching, training and anti-stigma campaigning.  She is an international role model for doctors with mental health problems and believes that we are human-beings first, doctors second. Last month, Dr. Walker co-hosted a free webinar on this topic as part of the Healer Our Healers initiative by Remedium Cares.

The problem

Medicine is a stressful business!  Working as a doctor in a hospital comes with many inherent pressures, uncertainties and risks at the best of times.  Throw a global pandemic into the mix and things get a thousand times worse.  The good news is that, despite the considerable challenges healthcare professionals are facing right now, they are increasingly being recognised for their resilience in the face of adversity and more support options are available than ever before (see end of blog for a couple of great resources!).

In this blog I would like to introduce some of the key themes we will be talking about and offer some simple tips and techniques for you to start managing your stress and anxiety today!

First things first

Stress and anxiety are completely normal human experiences.  They can both be very unpleasant – but they are nothing to be afraid of and they will always ebb and flow.  Stress is our body’s way of responding to threat and keeping us safe.   And anxiety, similarly, can alert us to something amiss and keep us on our toes and ready for action.   It is only when either of these perfectly healthy responses gets out of control that they can cause us problems.

Stress and what to do about it

We all get stressed sometimes, and that’s ok.  Stress happens when the demands placed on us are too high, or the resources we have to manage the demands are too low.   Hence why stress is such a common problem amongst hospital doctors!
Feeling ‘a bit stressed out’ from time to time won’t do you much harm, but if you are exposed to continuous stress for prolonged periods of time without adequate rest it can lead to problems.  You may start to get physical symptoms like persistent muscle tension, aches and pains, headaches and restlessness.  Or you may notice mental health consequences like being constantly irritable and snappy with your loved ones or starting to lose the enjoyment in life.  If you can recognise any of these symptoms in yourself then please take them seriously – this is your body and brain’s way of telling you things have gone too far.
The first thing to do is to get some help, speak to someone like your GP or a coach, and let them know what you are noticing.  They can help you to explore what is going on and where you might need some help in reducing your burden/demands and increasing your personal resources.  Secondly – focus on the basics of looking after yourself – like eating and drinking regularly, sleeping, getting some form of exercise/ movement daily and spending time connecting with friends.  This may sound simple, but this is the quickest way to start to relief the feelings of stress.
You might also like to build in more times in the day when you switch off your sympathetic nervous system, and drop into your parasympathetic response.  Simply practising a few deep breaths for 1 minute 3 x a day would be a great place to start.  Google ‘box breathing’ – it’s brilliant and you can do it anywhere, without anyone noticing – at the bedside, in theatre, in the canteen or hospital mess.  Finally – remember to plan in specific times to unwind – daily, weekly, and monthly.  We spend a lot of time getting stressed out – we need to take at least as much time to get unstressed again!

Anxiety and what to do about it

Remember – anxiety is normal.  We all feel worried and experience the physical symptoms of anxiety from time to time.  So the first thing I would suggest is to try not to worry about worry, it just makes things worse.  Remind yourself that we all get anxious and it will pass eventually.  Secondly, remember, that when something like a global pandemic comes along and your whole world gets turned upside down, and for the first time ever your patients might actually kill you and not the other way around, it is really reasonable to feel worried about things.  Similarly, if you have any of life’s others stressors going on, like divorce, moving house, raising children or caring for an ill relative, it is to be expected that you might feel worried or anxious.
However, a bit like stress, if your anxiety becomes so severe that it is impacting on your ability to do your job safely, or making it hard to get through the day – then please speak to someone about it.  There are numerous effective strategies to help reduce anxiety and you don’t need to suffer on in silence hoping it will just go away.
Anxiety often manifests as physical symptoms and can affect nearly every area of the body causing headaches, dizziness, blurred vision, tinnitus, dry mouth, breathlessness, chest pain, muscle tension, nausea, butterflies, diarrhoea, trembling, restlessness – you name it – it is the great mimicker of all diseases!  And as doctors we can often jump to conclusions very quickly and imagine we may be suffering from some rare or fatal illness.
If this is you – and you find yourself (like I do) lost down a rabbit hole googling all the possible causes of your symptoms, I’d suggest stepping away from your phone/screen for a bit and engaging in a little self-reassurance and distraction.  Nine times out of ten the symptoms will ease within minutes.  You could try listing all of things you are grateful for, or watching a funny clip on YouTube, or maybe try a grounding exercise where you focus in detail on all the things you can see, hear and touch in this present moment.  It is more difficult to feel anxious when you are feeling grateful, amused or distracted.
You may experience anxiety as more of a mental phenomenon, manifesting itself as excessive worry and rumination.  If this is you, again distraction and grounding can help.  Also trying to notice your anxious thoughts and gently challenging them may help.  Is it really likely that the thing you most fear happening is going to happen?  When you think about it logically, weighing up the evidence and risks, what is actually the most likely outcome?
Sometimes it is hard to get out of an anxious state by yourself, and that is ok.  We are not meant to exist in isolation on this planet.  We all need help from other people sometimes.  So look to those around you for support.  If you can’t distract yourself from anxious thoughts and symptoms maybe call up a friend and ask them to.  If you get stuck focusing on your palpitations, maybe ask a colleague to go for a walk with you for five minutes and see what happens.  Set an alarm for 15 minutes time, distract yourself with a job or chore and when the alarm goes off see how anxious you feel then.  You may be surprised.

Want to hear more?

If you would like to learn more about ways to control your stress and anxiety as a hospital doctor and for a link to our recorded webinar then please get in touch with us:

During our webinar we shared some very practical, realistic tools that many doctors are currently using to help themselves through these challenging times.  We all know that being a hospital doctor is uniquely challenging, and sometimes all we need is the time and space to think about ourselves, to make small practical changes to our day-to-day lives to feel better.

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