Stress

What is stress? Most of us have a working definition. Our patients get stressed and come to us for relief. Maybe it is stress within the family unit, or at work, or with a friend or a societal affray. We feel anxious as a result. High pulse, dizziness, a sense of dis-ease, insomnia or GI upset, a higher awareness of “things going wrong.” It takes many forms. In my career, it would be palpitations, headaches or “weak spells,” often investigated with a Holter monitor, blood tests and assorted specialty consultations. Hormones surge, tempers flare, and friendships are strained. My financial advisor said, “I’ve been told my cortisol levels are sky-high.” I believed her.Over the last 100 years, Western society has evolved to become less accepting of poverty, young death, suffering, personal control and taxation. Eighty years ago, we had financial insecurity and war, ill-health and homelessness. Now we have less of that and more and more “stuff,” yet we may still feel unfulfilled. We are left wanting of more. Advertising companies and the media tell us so. This sense of underachievement is a driver of stress. Let’s look at the world this year. U.S. tariffs came along, and everyone felt insecure. Someone kicked the hornet’s nest, and this developed into war in the Middle East. Uncertainty, confusion, and fear have heightened, with anxiety and stress are more prevalent than before. Just changing the economic landscape has a profound effect on “well-being.” More people will have insomnia, be upset at work and with their partner, develop constitutional symptoms and become unwell.Don’t underestimate stress. Higher rates of arrhythmia, angina, MI and stroke, hypertension and suicide will lead to higher global morbidity and mortality. Societal changes can cause illness. We know from past studies that an elevated heart rate is bad for you. If your resting heart rate is over 84 bpm, you have a 55% greater risk of cardiovascular death, and a 78% greater risk of death from all causes. Anxiety, depression and fatigue are recognized sequelae of chronic stress. How often is “increased stress” mentioned on a death certificate, although it is recognized as contributory to substance abuse, cognitive decline and suicide?What does this mean in your workplace? Expect less of your patients, understand the pressure they live with, give them more time to unload, counsel them with compassion and empathy, and treat what you can with what you can (a listening ear, or medication). When was the last time you congratulated a team on a successful outcome or said to a colleague, “You do good work?” When was the last time you told your spouse, “Thank you for what you do when I’m not there to help?”We are human too, as vulnerable to the pressures of life as the next person. We are held to high standards by our professional organizations. How often have you been acutely stressed, and chalked it up to, “Well, it’s what the job demands”? In my 40-year career, my nurses and I debriefed on only one cardiac arrest (a six-year-old child). Eh? That doesn’t sound right. I’ve had times when friends died in my care or when I felt no emotion at a funeral. I’ve had times when life depended on a challenging procedural skill (one I didn’t have) or I was the butt of an unfair criticism.We all know these stressors. Can we agree that admitting vulnerability is human, and being human is what makes us better people, and better doctors?And that stress makes all of us sick.Dr. Hector Baillie is a community general internist working in British Columbia. He writes about interesting cases and concepts that might stimulate discussion and change.

Stress

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Hector Baillie

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