Managing stress in a rewarding yet relentless healthcare system
I've noticed how the conversation about stress with clinicians and healthcare leaders often focuses on individual resilience. While personal coping strategies are important, the reality is more complex.
Let me share some insights I have learned and offer some stress management tips that can help you stay well in a challenging healthcare environment.
It’s important to understand your own stress response
Your brain doesn't distinguish between clinical or operational emergencies and a demanding email - it responds to all stressors with the same physiological reaction. Iv’e said this before, think of your stress response as a smoke alarm going off, it produces the same alarm whether it be a raging fire or simply burnt toast.
This means that a difficult conversation with a colleague can trigger the same heightened reaction, where your body produces cortisol and adrenalin, as managing a real clinical crisis. Understanding this helps explain why you might feel equally drained by interpersonal challenges as by clinical or operational demands.
The key is to create space between the stress stimulus and your response so you give yourself time to choose your reaction rather than going on auto pilot. Do this by noticing your initial response, being curious and engaging your rational brain before you act. Get perspective - ask yourself what assumptions are you making? What are your beliefs about the situation (what is the narrative in your mind), is it true? What are the facts?
Stress can have a cumulative effect
Many people I coach describe feeling like they've become less resilient. The truth is, it's not about them having decreased resilience, it's about accumulating stress over time. Each stressful event, whether major or minor, can affect your overall wellbeing and knock your internal stability. Without building in regular recovery time, to reset and restore, this increases, making each new stressful event feel more impactful.
How to break the cycle
It can feel that advice about stress management often doesn't fit the realities of working in a healthcare environment. It can be unrealistic to aim for eliminating stress completely. Instead, focus on tactical stress management:
1. Build in recovery windows
In the same way we need recovery after exercise, building in intentional small restorative breaks can help reset your stress response system. A few minutes of conscious breathing between patients or taking a proper lunch break can make a significant difference. It's not necessarily about duration (although it is important to take regular leave and not to allow that to slip) - it's about giving your system a chance to return to baseline.
2. Work out what is in your control and what is out of your control
While you can't control many aspects of healthcare, you can control your response patterns. Identify the specific moments where you have choice; perhaps in how you structure your day, when you check emails, or how you respond to non-urgent requests.
3. Make time for social connections
Research shows that positive social connections are one of the most effective buffers against stress. It can be isolating as a doctor working in busy environments and moving around a lot. Make deliberate efforts to build and maintain supportive professional relationships, and make time to connect with family and friends so you can download your frustrations and stresses in a safe space.
The responsibility for managing stress is not just yours
With the best will in the world, managing your stress isn’t just down to you - it's systemic. While individual stress management is important, don't fall into the trap of seeing it solely as a personal responsibility. Good organisations will offer opportunities to support you manage stress, this might be Shwartz rounds (a space to debrief after stressful events) or wellbeing initiatives.
Moving forward
The goal isn't to eliminate stress - that's unrealistic in healthcare systems. Instead, aim to create healthy behaviours and sustainable patterns that allow you to maintain performance at work without compromising your wellbeing. This might mean getting enough sleep, eating well, setting clearer boundaries, delegating more effectively, or restructuring your workday to include recovery periods.
Remember, it’s okay to not be okay and to ask for help. Managing stress effectively isn't a sign of weakness - it's an essential leadership skill that benefits not just you, but your team and patients as well.
There are some resources and organisations that support the wellbeing of doctors and healthcare professionals:
Doctors in Distress: a charity whose mission is to protect mental health and prevent suicide in healthcare workers https://doctors-in-distress.org.uk/
You okay doc?: a charity that aims to change the perception of mental health for those working in the medical sector and to develop mental health support for doctors https://youokaydoc.org.uk/
NHS England offer support for NHS workers who are experiencing stress: https://www.england.nhs.uk/supporting-our-nhs-people/support-now/
In Scotland, NHS workers can access the National Wellbeing Hub: https://wellbeinghub.scot/