By Matthew Goldenberg, D.O. Are you feeling stressed on the job? Here is some reassuring news: Stress is not all bad. In fact, research indicates that occasional episodes of stress can actually act as a performance enhancer, boosting focus and alertness. However, if stress levels get too high or become chronic, the result can be detrimental. For example, chronic exposure to stress can increase the risk of heart disease, stroke, and burnout, which can lead to anxiety, depression, insomnia, substance use problems and suicide. Taking a step back from the stress is the obvious solution. However, that is easier said than done. What if your profession is one of the many in which stress is part of the job description? That’s how it can feel for those in high-responsibility and high-pressure careers such as physicians, pilots, attorneys, CEOs and others. For many, extreme workloads and expectations become the norm and there is daily intense competition. For physicians (and others), patients/clients lives or livelihoods may directly depend on your success and your ability to thrive under pressure.
Hyperwork and Ethical Suffering
So what do such professionals do when the job stress becomes too much? Often, they’ll adopt an endurance mindset and simply try harder to meet the demands — a state known as “hyperwork.” This may be manageable as long as some downtime is scheduled; however, moments of respite all too frequently get put on the back burner as the career (and demands of life outside of work) continues to intrude. Going beyond the call of duty then becomes expected — it becomes the new “normal.” This is unfortunate in so many ways. Not only is it a recipe for burnout, it allows organizations to avoid dealing with their own structural, staffing and cultural deficiencies — ones that may be directly pushing their workforce to strive for more than can be achieved, to the eventual detriment of all. In the case of physicians, burnout among doctors has been directly tied to patient satisfaction and outcomes. Additionally, a culture of “hyperwork” can also lead to what is termed “ethical suffering,” a profound conflict of values in which the person is no longer able to live up to their own standards or the standards of their profession due to constraints over which they have no control. Consider, for example, a doctor working in the health care field, a profession that is well known for its punishing workload and for promoting a culture of endurance and perseverance. It is not uncommon for a physician to struggle to keep up with expanding job requirements, growing patient loads, the increasing demands of electronic medical records and other requirements of modern medical practices. In many cases, doctors are forced to spend less time with patients than they feel is appropriate or take other distressing shortcuts, which go against their core values or the reasons they initially went into medicine. The alternative is wearing down their physical and/or mental health trying to do it all. Sadly, the more conscientious and dedicated the professional, the more susceptible they are to symptoms of ethical suffering and burnout. As a 2015 Canadian analysis of doctor stress noted: “Self-denial and altruism, so valued by the medical culture, may represent serious risks to physicians’ health and stability, and impede their ability to deliver quality health care to others.” In a 2012 U.S. survey, close to one out of every two physicians reported symptoms of burnout, which in its advanced stages can cause work to seem meaningless, prompt them to detach emotionally from others in order to keep doing the job, and lead them to feel exhausted, professionally ineffective and hopeless.
Tips for Tackling Stress
Though job stress isn’t completely unavoidable, with effort and attention, it can be minimized and prevented from spiraling out of control. Among the steps that can help:
- Strike a work/life balance. If you are like most professionals, there is always work to be done. But you help no one if you fail to schedule downtime to enjoy the company of others, pursue favorite pastimes or simply do nothing. It just makes you less able to deal with stress when it comes. And if you always prioritize career over family, friends and nonwork experiences, you risk missing your own life. Remember, if the cabin pressure on the airplane fails, and the oxygen masks come down, you have to put yours on before helping your child. This is a great metaphor for professionals to remember: You first have to take care of yourself to be able to care for your patients/clients.
- Avoid the quick fix. Alcohol and drugs can seem to offer an easy way out of your stress, but the relief is temporary. And you run the real risk of adding one more stressor to your life — addiction. If you do realize you are having trouble with substances, reach out for help without delay. Most professionals have organizations that will help guide them into substance use disorder treatment and monitor their recovery. And the good news is that because of this oversight and because professionals tend to have such high motivation to return to their careers, the group tends to have much higher recovery rates than the general public.
- Encourage organizational change. If you are employed by an organization, push it to take the well-being of its staff into account. Remind them that happy workers are better workers and have happier patients. Health care organizations tend to focus on patient care and on reducing costs when trying to improve, while forgetting to factor in the needs of their own staff. But research shows that high job satisfaction by physicians translates to better patient care and fewer medical errors. Most crucially, push for as much control as possible over your professional life. It can be a lifesaver, according to a recent Indiana University study, which revealed that “those in high-stress jobs with little control over their workflow die younger or are less healthy than those who have more flexibility and discretion in their jobs and are able to set their own goals as part of their employment.” If your company culture can’t or won’t change, it might be time to freshen your resume.
- Recognize that your strengths can be weaknesses. All the traits that got you where you are today can come back to haunt you when you’re on the job: your dedication, your work ethic, your perfectionism, your intelligence, your belief in your talents. All of these can cause you to overcommit and expect too much from yourself, and to feel guilty and distressed when you inevitably fall short. Instead of buying into the fiction that professionals must never show any cracks in their armor, allow yourself to be the human that you are. This not only helps you, it helps your workplace culture, by allowing others to be seen as imperfect too.
- Take time for stress reduction. Explore proven ways of dealing with stress that will also boost your overall well-being, things such as exercise and mindfulness meditation. You might also consider joining a support group for fellow professionals who share your struggles. Or create your own. Such support not only helps you reconnect with what is most meaningful to you in your professional and personal life, it acts as a powerful and reassuring reminder: You are not alone.
Reaching Out
Perhaps most important when dealing with stress is recognizing it when it comes, and taking steps to deal with it before it becomes so entrenched that burnout is inevitable. Pay attention to irritability and fatigue, which can be early signs of stress. And if you are not able to bounce back on your own, arrange for the care of a mental health professional. Admitting you need a hand can be a daunting thought to those who have been indoctrinated to believe they must rely only on themselves. And, of course, it is natural to think about the effect on your professional reputation if you reach out and seek help. But the truth is you are much more likely to jeopardize your career — and more — if you need help but never reach out for it.