Stress in General Practice by Dr. M. Feldman. Stress in General Practice z3/4 GP have been Rx for...
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Transcript of Stress in General Practice by Dr. M. Feldman. Stress in General Practice z3/4 GP have been Rx for...
Stress in General Practice
byDr. M. Feldman
Stress in General Practice
3/4 GP have been Rx for depression
Not another guide to Stress in GP 94
3000 GP alcoholic
Alibane RCGP 88
3x SMR of suicide in GP
Murray 88
Makin, Rout Cooper RCGP 1988
20 GP in ManchesterStress due to
Interruptions Emergency calls/Night work
Emotional involvement Administration Home work interface
Financial Pulse 91
Stress due to
Night calls
Administration
Contact with dying
Dealing with
relatives
Lack of recognition
24 hr cover
Solutions Time management Decrease interruptions Decrease paperwork Good staff relationship Delegation Exercise Relaxation Protected time
Howie
Stress occurs when appointment times do not equal time required in consultation
Therefore always under pressure to catch up
Stress and the GP Howie, Levinson and Porter
Stress due to Work Overload felt by 20% of GP Indirect consultations e.g. phone Tedium Terminal care Family commitments
Stress and the GP Howie, Levinson and Porter
Type A - more commitments,
difficulty involving in family life,
responds by working faster
Type B Slows down and relaxes
Stress and the GP Howie, Levinson and Porter
Mechanic
Withdrawers Low social, low tech unhappy
Technicians Low social, high tech
unhappy
Councillors High social, low tech
Moderns High social high techThese are personality factors not related
to input in medical school
Cooper Rout Foragher BMJ 89
1817 GP in EnglandMen more stressed than women
Demands of job Patient expectations Work /Home interface Interruptions Administration
RCGP May 89
Average GP works 73 hours per week
of which 54 hours on call
Average consultant works 41 hours
per week
Occupational Stress in GP 1988 Journal of Management in Med
Stress
Minor illness
numbers
Chronic illness
Admin
Answers
Nurse practitioners
Counselling by CPN
Admin help
Computerisation
Not another guide to Stress in GP August 94
75% treated for depression Worse affected -young, single, urban areas
Stressors Emergency calls in surgery 82% Night calls 68% Time pressure 68% Problem patients 62% Admin Fundholding
Sick Doctors 1996
National counselling service for sick
doctors
Informal 400 per year
BMA stress counselling service
800 calls from April to June
Stress anxiety and depression in consultants, GP and managers 1994
27% of GP depressed6% of hospital managers depressed
15% of GP suicidal thoughts5% of hospital consultant suicidal
thoughts
Occ Med 1994 Ruth Chambers
700 Staffordshire GP 13% depressed 60% exhausted or stressed on > 3/7 per
week 50% have sleep problems
Worse in 40Stress predicted by
Anxiety Paperwork at home > 3/7 per week No hobbies Sleep problems
Stress Surveys in GP
Coventry 1:3 GP suffered panic attacks in last 3/12
1994 Pulse Suffolk MAAG Emergencies -> stress in 82%, night calls
70%1996 Queens Uni Belfast
30% have considered leaving GP 60% do more than 2 hours per week at
home
1996 June West Midland Survey of GP registrars
Major stressors Family / Job conflict Working for RCGP Patients unrealistic expectations Disruption of social life
Registrars better than principals for Job satisfaction hours of work
Worse for Rate of pay Recognition
Doctor Survey 1999
3002 GP’s =10% of total 53% Job damaging health 50% stressed
31% Back Pain24% Dyspepsia23% Insomnia20% Migraines20% IBS17% Depression
National primary care research 2003
2000 principals , 600 salaried gp, 400 locums
Worst in partners, men – age 40-49Worse since lat survey in 1998Main factors
Workload Paperwork Not enough time
Stress
The confusion created when ones mind over-rides
the body’s basic desire to choke the living shit
out of some asshole who desperately needs it
21
Optimum performance
Burnout /Breakdown
Rustout
HIGH
LOW STRAIN / PRESSURE
pERFORMANCE
Pressure or stress
22
Pressure or stress two types of people
23
Different Perspectives of stress
Stimulus based
Noxious environment - heat, cold, lack of sleep
Social ridicule / failure / bad relationships
24
Different Perspectives of stress
Response based
General adaptation syndrome 1}Alarm reaction - defence mobilisation -
lowering of resistance
2}Stage of resistance - coping mechanisms resistance restored
3}Stage of exhaustion - Adaptation declines
25
Different Perspectives of stress
Interactional models.
Outcome dependent on interaction between person and environment
Cooper - Stress due to misfit between perceived demand and perceived abilities
Cox - Stressor - perception of stress -> appraisal of ability to cope -> stress reaction
26
Stress and Absence Some Cost Estimates
40 - 80 million working days / £1-2 billion p.a.
( HSE )
£5.3 billion cost of certificated absence for anxiety
and depression ( CBI )
30% of sickness absence ( BA )
40 % of sickness absence ( Post Office )
60% of sickness absence ( Cable & Wireless )
27
HIGH
'Optimum
Performance’
P
E
R
F
O
R
M
A
N
C
E
'Rustout' 'Burnout'
LOW HIGH
P R E S S U R E
The true cost of stress
Marking for Stress Scale
Q1… a=0 b=1 c=2 d=3
e=4
Q2…1 for each “Yes”
Q3…0 = Yes, 1 = blank , 2= No
Q4/4/6/7 ……... 1 for each No
Q8……………. 1 for Yes
Q 9-14………... 1 for No
Q15……… a=2 b=1 c=0
Q16………… a=0 b=1 c=2
Q17………… a=2 b=1 c=0
Q18………… a=0 b=1 c=2
Q19………… a=2 b=1 c=0
Q20………… a=0 b=1 c=2
Q21………… a=0 b=1 c=2
Q22 Score as the number
written
Distribution of Stress Scores
0
5
10
15
20
25
30
35
40
<5 <10 <15 <20 <25 <30 <35 <40
Stress Scores
Average = 14.4
Minimum= 3
Maximum= 40
SD= 7
Company Av 10.8 - 19
Company Types Average Scores
Financial Advisors (sm) 11.1 Power Generation 12.0 Agrochemical 12.7 Chemical 14.4 Pharmaceuticals 14.6 Pharmaceuticals 12.5 Pharmaceuticals 16.2 Car Delivery 17.5 Insurance Financial (lge) 19
Factors influencing the severity of stress
Effects of Stress
33
Factors influencing the severity of stress
The Stressor
Multiplicity of stressors.
Severity and duration
Imminence of harm
Unpredictability, Ambiguity and uncertainty
34
Frequency of Consultations in year leading to redundancy
High rate
NormalRate
RedundancyAttendanceper year
Time
35
Factors influencing the severity of stress
Personal characteristics
Knowledge / beliefs / values - the event
Knowledge / beliefs / values - ability to cope
Personality characteristics
Susceptibility and anxiety
36
Factors affecting accidents in female athletes
Social support+
Coping skills
Social support
Coping skills
Neither
Social support+
coping skills
Social support+
coping skills
37
Factors influencing the severity of stress
Social support
Emotional support
Information support
Tangible support
38
Factors influencing the severity of stress
Self Esteem
Self Confidence
39
Factors influencing the severity of stress
Self Confidence
Experience Unconditional support Value System Skills:-
Change Lack of hostility
Powerlessness Not needing
approval
40
Effects of Stress
Short Term
Fight or flight
Long Term
Physical - Many different body systems affected
Social - Work and home - Stress Spiral
Psyche - Anxiety / Depression
41
Long Term Physical
Cardiovascular
Gastrointestinal
Respiratory
Skin
Reproductive
Neurological
Immune
42
Long Term Psychological
Addiction
Insomnia
Depression / anxiety
43
Social
Marital Problems
Relationship Problems
Stress Spirals
44
Coping Strategies
Poor
Avoidance - Buck passing, running away
Denial - What stress?
Alcohol, smoking caffeine and other drugs
45
ALERTNESS
COFFEE
SLEEP LINEBOOZE
COFFEE + BOOZE
Graph to show effect of alcohol and caffeine on alertness
46
Coping Strategies
Behavioural
Symptom Reduction
Cognitive
Others
Coping Strategies
Some techniques
48
Coping Strategies
Behavioural
Time management
Assertiveness
Social Support
51
Coping Strategies
Symptom reduction
Progressive Relaxation
Relaxation through Visualisation
52
Cognitive Strategies
Changing your perception of events
Utilising the power of your brain to
reduce or eliminate stress
What you think is what you feel
53
How stress effects your thinking
Distorted thinking, generalisations, magnification of problems, personalisation of events
Automatic thoughts
Tunnel vision
54
Selective abstraction
Obsession with loss Depression
Malice of others Anger
Multiple Dangers Anxiety
55
Reappraisal
Constructive self-talk
Quick recovery
Thought stopping
56
Positive thinking
Focus on the future, not the past
Positive meanings, positive approaches
Giving yourself support,
encouragement, messages
Use humour
Turn problems into opportunities
57
Behavioural / Cognitive
Creative problem-solving Prevents / reduces panic; provides structure;
uses the right side of the brain as well as the left
STATE - OUTLINE - LIST - VIEW - EVALUATE
Stress inoculation training Combining diverse methods ( information
seeking, imagery, behaviour rehearsal, task organisation, relaxation, anticipatory problem solving ) to prevent stress
58
Coping Strategies
Other Techniques
Goal Setting
Meditation
Biofeedback
Reflexology
Homeopathy
Acupressure
Hypnosis
Physical Exercise
Rest and relaxation
Retreats
Colour Therapy
Places to get help
Your GPBMA councelling serviceBritish Doctors and dentists groupBritish Association of councellingCOPE councelling for gp.’s Doctors support lineDoctors support network
Stress Management
The End
Help
GP care
Health at work in the NHS
National Association for staff support
National coucselling service for Sick Drs
Sick Doctors Trust