Release the pressure

New FYi editor and F1 trainee Dr Rebekah Skeldon looks at ways of coping with the stress of medical training

STRESS. The very word is enough to give you palpitations. And after five or six years studying at medical school, writing endless job applications and embarking on foundation training, you are probably all too familiar with the concept. There’s a lot of pressure put on us as trainee doctors and while pressure can be a positive force in motivating us, too much can have the opposite effect.

Stress is a natural reaction to too much pressure, according to official definitions. It’s what a person experiences when they feel the demands of their work are greater than their ability to cope. But it is not enough just to know our jobs can sometimes be stressful – it’s vital that we can recognise when we are becoming too stressed and take action to deal with it.

The first step in handling stress is learning to recognise the signs in yourself. It sounds simple but in the midst of a hectic ward when you are busy worrying about how your patients are doing and you have a list of jobs as long as your arm, it’s very easy to forget to ask yourself ‘how am I doing?’ Some typical symptoms of stress include feeling overly tired during the day, poor sleep at night, frequent headaches, loss of concentration, poor memory, irritability and frequent colds/minor illnesses. Sound familiar? Then read on.

Get organised

There is no easy fix or magic pill that will ease the stress of the job but there are lots of small things you can do each day (or night) that can make your shift go more smoothly. Being organised is a great start. This may come more naturally to some people than it does for others but it is a skill you can improve with practice. Firstly, keeping an up-to-date ward list with patient names, Community Health Index numbers (in Scotland), date of admission, diagnosis/current issues, date bloods requested and jobs column will not only help you remember important information about your patients for ward rounds but will help colleagues covering your caseload when you are on annual leave or off sick.

Secondly, a ‘bloods folder’ with all your patients’ results clearly laid out on a single sheet is invaluable. It will save you many trips back and forth to the computer and avoid the need to search through multiple results screens to determine trends, for instance, in renal function. Finally, always have with you, either in the bloods folder or on a separate clipboard, various blank request forms, discharge scripts and continuation sheets so that you can impress your consultant by multi-tasking on the ward round. If your consultant/seniors perceive you as being even mildly competent in this domain then you can avoid some of the disapproving looks or tellings-off. You may even be entrusted/rewarded with the opportunity to do the odd new practical procedure or two.

Swift action

Don’t let stress build up to the point where you start to feel overwhelmed by your job – it’s best to recognise it and tackle it early. When doing my highly unscientific research for this article, many of my fellow FYs thought that simple strategies such as taking a deep breath and counting to 10 could be quite effective. They also highlighted the importance of asking for help when you are busy or having difficulties. This may be a case of just asking a less busy colleague if they could help with some of your jobs or it may mean asking them or your senior for advice on how to manage a particular situation or problem.

One other popular suggestion to ease stress levels was to ‘have a rant’. Obviously, having a stand-up row or hysterics in the middle of the ward is not the way to go, but a quick chat in a sympathetic ear, whether in the doctors’ room, the mess or at home, can help release some of your frustrations.

Another key to maintaining your sanity, especially during long shifts, is to ensure that you take your allocated breaks. If you are fortunate enough to have a doctors’ mess in the hospital where you work then do make good use of its facilities. It’s a great place to catch up with other FYs and share some of your experiences (whether good, bad or comedic), ask for advice, compare notes about your seniors or just simply organise your social life, however much of it you have left. If you have no mess, try to at least escape the hustle and bustle of the ward, the change of scenery will do you the world of good. Don’t fall into the habit of eating your lunch in the doctors’ room. Not only will you be frequently interrupted by requests from the nurses to, for example, prescribe fluids/amend a kardex for your own patients but you’ll probably be asked to do similar jobs for your colleagues’ patients seeing as you are there and they have left the ward to have their lunch.

Be healthy

In general, a good way to beat stress is to try to lead as healthy a lifestyle as possible. For starters, always eat something for breakfast as lunch may be hours later than planned. Keep some healthy snacks handy, like fresh or dried fruit, to keep you going until break time. Also, bring in bottles of water or other healthy drinks so you don’t become too dehydrated. Coffee and chocolate offer a quick fix and, unfortunately, tend to be readily available in the hospital. But that sudden caffeine or sugar rush will not last long and you will likely feel more tired and less energised once the effect wears off. Most importantly, always try to get a good night’s sleep.

It is all too easy to become engrossed in all things medicine. But it is essential to have outside interests and friends so that you can let your mind switch off at the end of the working day/week. Sport and exercise are well known stress-busters and a great way to meet new people, but if you are not athletically-minded, a less energetic hobby or interest can be equally therapeutic. For more hints and tips on leading a healthier lifestyle and stress management, including a ‘stress test’, you can visit the NHS Choices website at www.tinyurl.com/6kku6ux. Although largely written with the general public in mind, it does offer some useful and practical ideas and advice.

If you are still finding things stressful and feel you need more help, speak to your clinical or educational supervisor sooner rather than later so that formal support mechanisms can be discussed and put in place for you at work. If that route sounds a little daunting then another option is to contact the British Medical Association who offer a national counselling and advisory service for its members, including medical students. Here you can receive confidential advice and support from either a trained counsellor or a doctor on any issue which may be worrying you.

MDDUS have also sponsored a useful and entertaining booklet by the BMJ for newly qualified doctors entitled You Will Survive. It is packed with useful hints and tips for coping with the stresses and strains of FY life along with a few cautionary tales and humorous anecdotes thrown in for good measure. To receive a copy contact Karen Walsh at kwalsh@mddus.com

Dr Rebekah Skeldon is in her first year of the foundation training programme and is editor of FYi