Stress has always been a part of my life. I have experienced it during exam revision, my Duke of Edinburgh expedition, being the captain of a tennis team and performing in a play. My reason for choosing this SSC was to help me to identify and manage my stress, plan my goals and improve my time management so that excessive stress can be avoided in the future.
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We began the course by studying the graph of performance versus arousal, illustrating the human response to stress. Performance initially increased with stress. I have always perceived stress as a negative thing and something that should be avoided at all costs. I soon learned that some stress is good for you; some stressors keep you motivated and working at the optimum rate; without them, I would become bored and feel like I was underachieving. When stress is excessive, however, the graph starts plateauing and then going down. The body starts suffering and displaying signs of being overstressed leading to lowered productivity and finally breakdown and illness.
When I am very stressed, I find myself experiencing a combination of symptoms. Anxiety, procrastination, increased heart rate, diarrhoea, sensitivity to criticism, negative self-critical thoughts and occasional emotional outbursts are not uncommon to me. Being on such a demanding course as Medicine, it is important to manage stress efficiently to keep productivity at optimum levels. Knowing about the manifestations of stress is useful both when directly administering healthcare and to inform professional conduct. The understanding of the manifesting symptoms of stress will allow me to identify it in myself and others: I can later use this either to prescribe the right course of action to the patient, or to manage underlying problems at work.
The two types of stress are acute and chronic. The General Adaptation Syndrome proposed by Seyle explains the stages the body goes through when faced with stress: Alarm, Resistance and Exhaustion1. The alarm stage involves the fight or flight mechanism as well as activation of the Hypothalamic Pituitary Adrenal axis, leading to down-regulation of the immune system. In the resistance phase, the body tries to cope with the increased stress. In the exhaustion phase, sustained stress has depleted the body of resources and we suffer from ‘diseases of adaptation’. I experience acute stress on a frequent basis, for example when I get a minor injury or am trying to meet an essay deadline, leading to alarm and resistance. Chronic stress is more long term, such as occupational stress, commonly leading to the exhaustion phase of the General Adaptation Syndrome. This occurs when I am stressed for a longer period of time, such as when struggling to catch up with work or preparing for exams.
Extended periods of high stress situations can lead to burnout, which is characterised by emotional exhaustion and depersonalisation, leading to low productivity and feelings of low achievement. I have experienced similar feelings when, after pushing myself too hard, I feel negative, run down and as though my work is barely progressing. The extreme demands of a medical career can easily drive a doctor to burnout. I was glad that this SSC gave us space to consider burnout, as it brought my attention to aspects of my own conduct when under pressure.
With an awareness of my personal difficulties in mind, I often try to use action and emotionally orientated skills to manage my stress levels. I plan ahead in terms of work and other commitments, and prefer to work steadily over time and not get emotionally ‘worked up’ about it. However, acceptance-orientated stress management comes into play when stressors seem more imminent. With the associated stress of an oncoming exam, for instance, I accept it and work, trying to avoid further stress by reminding myself that I am doing my best.
I was surprised to learn about the extent to which personal stress effects those who surround us. Stress is infectious and in a clinical scenario it is important to seem calm to the patient to build a rapport and gain their trust. A visibly stressed doctor will result in stressed patients, or even cause stress in other members of staff leading to poor patient care, often due to non-verbal communication such as body language. With the understanding that interactions with patients, and teamwork situations will feature a lot in my career, knowing about the infectious nature of stress has reinforced my belief that I must manage my stress and be cautious of how (or what) I communicate.
To improve my stress management, it is important to become aware of my stressors, and how I react physically and emotionally to them, while bearing in mind the three main variables of stress: intensity, duration and number of stressors present. This will allow me to evaluate what I can change and to moderate my physical and emotional responses. Keeping fit by going to the gym and playing sports, as well as socialising allows me to unwind and feel good about myself. I find these very effective in stress management as they allow build-up of physical and emotional reserves. However, I need to improve my prioritising mechanisms, as sometimes prioritising is my downfall: for example I often find myself persuaded to go out with friends before an important deadline. Doing work when it is important rather than urgent will also leave me room to do the things I enjoy, without the avoidable pressure of time constraints and outstanding work: thus by starting assignments sooner rather than later, and studying lectures and tutorials after having them I will reduce my exposure to the stressors, and the intensity and duration of the stress
With those plans in mind, I found learning about the methods of stress manipulation – halting, interrupting and coping – useful and insightful. In the past I have used halting and coping as my primary methods of manipulating stress. However, I now feel that these are not best in all situations; indeed, they can result in more when work accumulates and must be completed later. I am now putting into place interruption, which involves reducing the stress rather than stopping it altogether by preventing it from building up; this works well when it incorporates the management of variables of stress.
I found it a surprise that such a thing as eustress existed; once again challenging my perceptions that stress is almost always a negative thing. I then recalled when I had experienced this in the past, for example when exams are over and I have almost unlimited time to do whatever I want.
Learning how to identify stressors, as well as enhancing relevant communication skills, was useful. As a doctor, using the interrogative words “Who, What, When, Where and How” when interviewing patients will help me to take good patient histories: they will allow me to direct the patient’s answers in a way which will help identify the stressors efficiently. The areas which cause stress are occupation, personal relationships, environment and non-work time. Using the aforementioned words will create open yet specific questions, prompting the patient to open up and provide a better history. However, the interrogator “why” should not be used as it is too vague and not productive enough when trying to determine the causes of stress.
Thought awareness refers to negative thinking. I have experienced this myself, when the approach of exams causes me to doubt my knowledge and anticipate failure. However, I have addressed this by making sure I prepare in enough time and by using my time efficiently. I am now able to think more clearly, remain calmer and make informed decisions in more stressful situations. I recognise the importance of being optimistic, and believe that even when things do not go according to plan, I must see the experience as positive and an opportunity to learn. As well as that, I am quite a confident person and apply myself to most situations with a confident mind-set even if they are in uncharted territory. This allows me to push my boundaries, and this boosts my confidence when I am pleasantly surprised to discover a new skill. On my Duke of Edinburgh expedition, I was leading my team. Unfortunately due to torrential rain and wind, a part of our route was impassable; this meant I was responsible to plan a new route within a short period of time as it was getting very late and dark. I successfully managed to get the team to the camp with very little delay to our original plan.
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The final step in stress management is rest, relaxation and sleep. In my experience, all three have suffered during stressful times, especially rest and relaxation. I play badminton, tennis and go to the gym as forms of recreation, and enjoy music and television to distract me from the stress. I sometimes stop doing these during intense times in order to make time for work. I now realise that it is important not to halt these activities. However the biggest change I will be making is implementing the self-hypnosis techniques learnt in the classes. I think that the hypnosis allows me to be more awake and refreshed than by taking a quick nap, which often leaves me feeling worse when I wake up which I learnt was due to me interrupting a sleep cycle.
To be someone who works productively, efficiently and in a professional manner, I must set realistic goals and then achieve them, borrowing some aspects of the tycoon mentality. Namely, it is necessary firstly to know what I want; the best way of going about this is to maintain focussed on it by not bothering too much about what I don’t want. To remain focussed on achieving my goals, it is important that I constantly visualise them to keep myself striving towards them. This means clearing your mind of any clutter such as goals that are now unattainable and past events. I often find myself thinking of what has happened in the past and replaying them in my mind and thinking about what I could have done differently, for example I once said something rash to a friend in the heat of the moment which I later regretted; I kept thinking about all the time and got really stressed. I now realise that this is merely a waste of time and I could use this time to make more use of the present to create a better future.
Tycoons realise the importance of compartmentalising, that is, not carrying emotional baggage from one thing to another. As a doctor for me this will be imperative: I must not carry any sentiments about one patient to another when dealing with another case. I already compartmentalise in day to day life, and for instance when I get upset about one thing, I do not allow the associated emotions to interfere with other aspects of my life. I have also set myself some clear cut and realistic goals which I am working towards and know how to get there. In some ways I do have tycoon mentality, which is valuable as a medical student and future doctor.
Although the importance of hard work is undeniable, anticipating success will help me to achieve it, as the ensuing excitement which in turn motivates me to strive towards my ambition. Anticipation also allows me to change my goal if my current goal no longer seems to be the right one for me. Past experiences have shown me that whatever seems like a huge effort will only become habitual in time, usually a period of three weeks according to Maltz’s Psychocybernetics2. For example, when I promised myself to visit the gym to improve my fitness, it initially seemed a huge effort to make time for it, but after some time I stopped seeing it as an effort. It became a part of my schedule, and I am able to fit other activities around it: this is goal maintenance
I have a goal in my career of becoming a liver surgeon, it is a definitive long term goal and I am determined to achieve it. I will need to achieve several goals such as passing my exams and attending surgical society meetings to achieve the long term goal. By having a time frame to achieve my goal, I will always endeavour to achieve the goals I set myself.
It is not just enough to have a goal; you need to make it a reality. I am good at operating on my own initiative and try to take the necessary steps to climb up the ladder towards my goals. Desire results in sustained effort: For instance, I will not let progress made towards my ambition deter me from trying harder. I am currently searching for placements with surgeons and gaining career advice to set me apart when I apply for a job. Loss of desire can mean you can get side tracked from your goals and result in you not achieving them; I am always trying to keep a focus on my goals in order to prevent this from happening. In order to gain satisfaction from achieving my goals, I need to make sure that I keep doing my on-going activities such as gym, tennis and badminton. Otherwise, I would have lost this aspect of my life as well as it being detrimental to my fitness. I am often guilty of stopping these activities when I’m busy with other work, but from now on will incorporate them into my goals.
Goals are something you want to achieve; dreams go beyond goals and are on the horizon beyond the path to your goal. This made me think whether some of my goals are actually goals or whether they are dreams. I then realised that my goal of becoming a well renowned surgeon is actually a dream, I will need to hit all my goals and go beyond before I can make my dream a reality. I also realise that no one is going to create my success; only I am solely responsible for creating my success. I have set SMART goals (Specific, Measurable, Achievable, Realistic and within a Time frame) and I am now forming a personalised goal portfolio so that I can hit my targets; to supplement this, I am also going to make lists of tasks that I need to do. Though I have never used lists in the past, I feel that making lists facilitates organisation and aids the memory, thus increasing chances of success.
I feel that this SSC has equipped me with a platform of skills which will be useful in my career as a doctor. Mainly these fall under the categories of stress management, motivation techniques, time management and relaxation. Surprisingly, though, the course has shed light on the importance of communication and body language with regards to stress management, and familiarised me with concepts I did not previously know about, such as eustress and the positive influence of stress for productivity. Nevertheless I feel that the most important things I learned were the skill of identifying that I was stressed, and the knowledge that sometimes I need to relax. Above all, though, I feel that this SSC has been one of the most influential aspects of my medical education, as it has taught me to recognise that stress is not merely a black and white issue: it ‘resides neither in the situation or the person, it depends on a transaction between the two.’3
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