January 15, 2021

The Bear in the Hospital: Doctors Between Worry, Anxiety, and Stress

In this article you will learn the difference between worry, anxiety, and stress and how to deal with all of them when on call.

The Bear in the Hospital: Doctors Between Worry, Anxiety, and Stress

We’ve all either seen or felt this. You’re on call in the ER with all these thoughts rushing in your head. “What if the patient dies? It will only mean one thing: I’m a terrible doctor. My career will be over.” Imagination aside, in reality your assistants are standing there staring at you, waiting for your next move. Seconds of this patient’s life is at risk (that’s stress), not because you’re a terrible doctor, but because you’re worrying about being a terrible doctor (that’s worry) and already imagining what the hospital will do. There’s a vibration running up your arm (that’s anxiety).

Take a few minutes of your time to find out how resilient of a doctor you are.

It might feel like you’re going crazy, but going crazy is just like the “Physician Personality,” it isn’t real. Your feelings are valid and your worry, stress, and anxiety can be dealt with, but first you have to identify which one(s) you have. There are 6 types of worry and we’ll get down to this in a minute, but basically to worry is to dwell on a thought: it happens solely in your mind. Stress is a physiological reaction to an existing stressor; psychologists usually refer to this as the bear chasing you in the woods and your adrenaline rushes in your blood so that you can run faster than you normally could. Anxiety is exactly that except that there is no bear involved.

The 6 Types of Worry

According to Dr Derya Özeş, a psychotherapist that has been coaching our Resilient Doctors this past week, there are six types of worry. It’s important to categorize our worries and put them in their places because some worries are proactive and some are self destructive.

Threat Scanning is when you’re always alert for any threats in your surroundings.

e.g. constantly checking for COVID symptoms

Hypothetical Worry includes “what if” scenarios and are usually about things you don’t have much control over.

e.g. What if I get fired?

Fortune Telling is when your mind interprets predictions as facts.

e.g. I will never be a good doctor because I lost a patient

Catastrophizing is basically jumping to the worst conclusions. Like when you’re in your second year in Med School and start thinking you have all the diseases you’re just learning about.

e.g. Medical Student Syndrome, when we believe we have all the diseases in our pathology coursework.

Practical Worries are based on logic and rationale, I’m worried that 1+2 won’t equal 4. So I’ll have to step up my game and turn that 1 into a 2 or that 2 into a 3. Unlike Hypothetical Worry you actually have control over these factors. This type of worry can help you be more proactive.

e.g. What if I spread the virus to my husband despite taking all precautions?

Emotional Reasoning is when your mind tells you that your emotions reflect reality. While emotions can act as helpful as messengers, they often aren’t reliable.

e.g. I feel guilty about my last patient so they must think I am not competent.

Which ones of these do you resonate with the most? Identifying this can help you regain control.

The Bear in the Hospital

Doctors have all the reasons to feel distressed. All the stressors in all workplaces are there in a healthcare institution in addition to the life and death factor. According to Dr Tait Shanafelt, director of  the Mayo Clinic Department of Medicine Program on Physician Well-Being, there are seven main stressors that medical providers face.

  • High clinical demands.
  • Low autonomy.
  • High government and reimbursement issues.
  • Decreased time with patients.
  • Difficulty balancing personal and professional lives.
  • Inefficiency and intrusion of EHR
  • Isolation

Self discipline is your weapon. Worrying is like toilet paper, the more you feed it the more it’s out of control. Stop these worrying thoughts from rolling. When you find yourself thinking too much about hypothetical scenarios or even dwelling on actual stressors, stop and start strategizing.

There are a few evidence-based tools that you can use at the hospital or at home. But these don’t always have to work. Just like with diets, our minds receive signals differently. Try the following tools out, if they don’t work for you, and your anxiety is still standing in the way, we recommend you consult with a psychiatrist

Evidence-based Tools to Face Stress and Anxiety at the Hospital

There’s a handful of evidence-based tools to use when coping with stress, according to Dr Özes.

Cognitive Behavior Therapy (CBT) is to understand the relationship between events, triggers, thoughts and our behaviors. How our thinking and way of relating to the situation influences the way we respond to it. Being able to identify the nature and validity of our thoughts and emotions help us respond in more mindful and informed ways than relying on instinct or habit.

Created by psychologist and researcher Dr Albert Ellis, the ABC (Adversity. Beliefs. Consequences) model is a basic CBT technique. It’s an equation that assumes your beliefs about a specific event are directly proportional to how you react to that event.

e.g:  A) Dr Jane becomes aware of some slight symptoms of anxiety.

B) “I can’t stop it now, then it will become totally out of control and the hospital will find out about my inefficiency.”

C) Dr Jane gets a panic attack and lights up a cigarette in the process.

With CBT, the idea is to replace unhelpful thoughts with alternative helpful ones focusing on evidence, the present moment, your values as opposed to your fears, your strengths as opposed to negative self-evaluations, being open and curious about the journey of change or challenge.

On the other hand, Acceptance and Commitment Therapy, or ACT assumes change and anxiety are inevitable, anxiety is a normal part of life. Instead of focusing on how to eliminate anxiety, ACT encourages acceptance and psychological flexibility. Only then can we practice cognitive diffusion.

There are three techniques for cognitive defusion. Have you tried thanking your mind? The idea here is not to take your difficult thoughts too seriously or get into a struggle with them. When your mind generates harsh and painful thoughts, you “thank your mind” in a somewhat sarcastic manner, perhaps similar to how you might respond to a rebellious teenager who is saying something provocative to rile you up.

e.g.: “Thank you for telling me I’ll be late for work as usual, I’ll set the timer to make myself more aware of the time.”

Labeling your thoughts is another technique of cognitive diffusion. Almost all thoughts are either descriptive or evaluative, call them by their name. Descriptive thoughts point to direct experience. Descriptive thoughts point out any aspect of something that we can perceive with one of our five senses. Evaluative thoughts pretend to derive absolute truth about the implications of that experience.

e.g.: “I notice my mind producing a memory.”

“I notice my mind jumping to conclusions”

With the same attitude, you can also catch your bad thoughts by repeating them slowly.

e.g.: “Patients must think I’m a bad doctor”

“Pa  tients…. Mu…...st…...think……” by the time you reach that point you’ll realize how ridiculous you sound.

Sometimes you’re your worst critic, don’t fall for your mind’s tricks. Fill the survey and join the newsletter below to watch Dr. Osez’s full videos to learn more about how to regain control over your mind and to get notified of our monthly calls with doctors all over the globe, who are dealing with issues similar to yours.

---

Before you head out, let me tell you a bit about Resilient Doctor. It’s a holistic program, for doctors, by doctors. We’re a bunch of health advocates working against physician burnout. The coaching program is divided into several modules. This month our participants have passed through the Stress Basics module, attending webinars, getting coached, and taking part in challenges. For more information, sign up to our newsletter here.