Watch Out For Early Signs of Stress



By Matt Borsellino

Medical Post

May, 2, 2000


SEABROOK ISLAND, S.C. - Re­sources for physicians on dealing with stress are available - it's just that doctors don't know where to look, according to an Ottawa-area psychiatrist specializing in treating colleagues.

The first such resource is a family doctor, Dr. Mamta Gautam told this year's International Conference on Physician Health. Too many doctors don't have a GP, and she urged those who don't to get one.


There are the five "early dan­ger signs" of stress, which should be immediately discernible to any physician's family and friends. They are:

increasing problems and ill­nesses;

more problems with relationships and a tendency to over­ react;

an increase in "negative thoughts and feelings;"

a significant increase in what Dr. Gautam called "bad habits;" and

exhaustion, which she described as "Mother Nature's way of saying you've done enough."


In many ways, physicians are their own worst enemies, Dr. Gautam noted. As many as one-third of physicians will have a "major incident" of depression during their careers, a problem she said is vastly under-reported.


"Doctors like to please people, but are uncomfortable with receiving love and approval," she added. "One of the foremost causes of stress is the perception of not having any control and having no choice."


As the Canadian health-care system is subject to more fiscal pressure and political posturing, more and more doctors are beginning to feel they've lost control. As a result, more will need to know how to deal with their stress.


First, she said, they must identify what's causing it. They should recognize they may have more control than they think over some of those factors. Dr. Gautam said doctors must focus on what they can control and learn to cope with what they can't. Physicians also need to focus more on themselves and "keep stress positive," Dr. Gautam noted. Crucial to managing stress is learning to look for options and saying no.

"Remember three things," she advised: "Open your mouth. Say no. Close your mouth." No explanations are needed.


Another approach to how to deal with the pressures of being a physician was given by Dr. Rachel Naomi Re­ men, a San Francisco­ based oncologist who said she doesn't believe medicine can be prac­ticed in its traditional way anymore. The best way to effect change, she suggested, is to start with doctors-in-training who experience some of the profession's heaviest pressures.


"It's possible that sci­ence is distracting us from the meaning of medicine, which is service," Dr. Remen said. "Medicine isn't a technique or a skill, it's a human relationship. Restoring a sense of service will require a radi-

cal reform of medical ed­ucation."


Some doctors these days mistakenly try to "cultivate an emotional distance" from their pa­tients, she added.


"Connecting makes some people in medicine nervous," she said, "but many more mistakes are caused when there is a disconnec­tion. Sacrificing yourself is nei­ther professional nor responsible."


Both Dr. Gautam and Dr. Re­men received standing ovations for their presentations.