Managing Stress in a Workplace Full of Risks

Pharmacy work can be highly stressful, and pharmacists who are under extreme stress are at risk for more errors, said Henry Cobb, PhD, MD, BS, CDM, Clinical Associate Professor, University of Georgia College of Pharmacy, Athens, Georgia.^[11] Pharmacists need to identify their own personal stress triggers and anticipate their responses to stress. He presented 5 questions that could be used for such self-analysis:

• How do you know whether stress is a problem for you?
• What is causing most of your stress?
• Is your supervisor aware of the problem?
• How do you deal with stress?
• What can you do to reduce the impact of stress?

Cobb described 3 ways that most workers deal with stress on the job. The active-cognitive person draws on past experience, taking one thing at a time. He or she considers several alternatives, looking for the positive side, and is able to step back and be objective. The active-behavioral person finds out more about the situation and takes positive action. He or she may talk with a friend or spouse, exercise more, or talk with a professional in order to find a solution. The person who practices avoidance keeps feelings to himself or herself, prepares for the worst, takes out frustrations on others, and eats or smokes more to reduce tension.

Identifying the phases of stress can be helpful. Phase 1, or the warning phase, includes vague anxiety, depression, and apathy. Phase 2, or mild stress, includes sleep disturbances, muscle aches, and irritability. Entrenched stress, or phase 3, includes alcohol abuse, depression, ulcers, withdrawal, and marital discord. Phase 4, or severe stress, includes asthma, heart problems, severe depression, violence (or suicide), paranoia, and uncontrolled anger. It is important to note that professional help is needed for phases 3 and 4.

To reduce stress on the job, Cobb presented this list of quick strategies:

1. Discontinue caffeine;
2. Engage in regular exercise (30 minutes 3 times weekly);
3. Practice relaxation-breathing exercises (20 minutes 2 times weekly);
4. Get adequate sleep (try going to bed 30 minutes earlier than usual);
5. Nurture your leisure time, engage in hobbies;
6. Set realistic expectations and avoid perfection;
7. Reframe your outlook to be optimistic, not pessimistic;
8. Eat right;
9. Maintain a sense of humor;
10. Talk and vent;
11. Write down your thoughts;
12. Avoid unhealthy habits (such as alcohol);
13. Set limits (learn to say "no"); and
14. Get help from a professional.

In some cases, however, a person who is in a job that does not match his or her personality and preferences may need to switch to another role or job, Cobb added. That may be a much better stress-reduction technique than any other.

Well, even if you don’t ask, I’m gonna tell you!

I’ve been sick - imagine that, a doctor, sick. But it’s been a very positive experience for me and will be the source of serveral blog entries.

I had a respiratory infection with first some days of just feeling cruddy (that’s not the word I actually used but it would have been censored). Then I had to fly to Washington, DC for a business meeting. By the time I got to DC, my throat was totally RAW and worse than I ever remember it being. But, here’s a good plug - the Hall’s MAX sort throat lozenges are phenomenal but I don’t think there are any more since I probably bought them all that week.

The morning after I arrived in DC, my throat was horrible but the bad part was that i couldnt breath while walking. This just got worse and worse so that any type of exertion had me really breathing hard.

By the time I flew home on Thursday I was too scared that this might be my heart to even take my migraine medication - and that’s being pretty darned scared. I arrived back in San Antonio at about noon, called and made an appointment and drove to the hospital and got admitted about 10 hours later. They ruled out a heart attack and a blood clot (pulmonary embolus) but weren’t sure what was really going on.

But that’s not important, I’m much better now. But as I was sick and really unable to do much for the last few weeks, including talk (thus no audio blogs for a while), I had much time to reflect on my life. I came up with the appropriate diagnosis and it began with an "S" - no, not that "S" word.

STRESS

As I looked back over the past year, it’s been a whirlwind and great year but it’s also been crammed full of stress. Stress that I have either created or allowed to build. We don’t have enough electrons to go into that but if you’d like a sleep aid, email me and I’ll tell you all about it - just kidding.

Seriously though, I understood it before but I firmly believe now that we  have to address stress in our life - or better yet, how to eliminate it. And a few good friends have given me advice - don’t let things I have no control over bother me. and even though that’s not easy, it’s certainly something we all should strive for. And the other is to ask ourselves "how can I have the most fun at this precise moment?" I think that’s the best of all and intend to try to work with that as much as possible. I can think of scenes for a sitcom perhaps or stories for a stand up comedian. Anything that will make things fun.

I had to turn my life around and know that there’s a bunch of stuff going on but it’s not stressful UNLESS I MAKE IT STRESSFUL.

Please take heed of this. Stress adversely impacts our immune system and without our immune system, we’re in big trouble.

There are some other "alternative" medicine things I’ve been exposed to also in the past few weeks that I may eventually share depending on my results. But combatting stress in whatever way you can is essential.

So, bottom line is that I’m back now and I’ll be posting away again. It’s good to be back and I appreciate all my readers!

Terrie

Boy is this a pertinent quip from Medical News Today .

In today’s world of very educated patients, most would be insulted if the physician even mentioned anything to do with depression. And yet, the universal presence of depression in the U.S. is phenomenal. Many people do not know that that is their diagnosis though. And therefore, they think that there "must be something wrong with me" - something that enough "tests", enough "diagnostic studies" - enough something - would show. The somatic symptoms of depression are multiple. And it should be considered in most scenarios. AND most patients should not be so resistant to the screening process. This resistance is what keeps physicians from even considering it as a diagnosis.

Providing a voice to an often silent disease, Epocrates, Inc. surveyed 500 clinicians to identify trends in depression diagnosis, prevalence and treatment. People dealing with stress, whether in the workplace or at home, should take note; nearly all clinicians identified stress as the leading contributor to depression.

The majority of clinicians reported seeing an increase in depression in the past five years, and believe this increase may be driven by greater disease awareness, and ultimately more patients seeking help. However, clinicians reported that many more patients may be experiencing symptoms that are going undiagnosed. More than half of survey respondents felt that physicians are hesitant to diagnose depression, primarily due to resistance from patients and lack of societal acceptance. Clinicians also reported uncertainty about diagnosing depression, as patients may present symptoms differently based on gender and ethnicity, or may be a product of another medical illness.

"In today’s digital age, the increasing pressure to get it done yesterday can lead to more stress and potentially depression. Early recognition and intervention are important to prevent the loss of jobs, damage to relationships or suicidal thoughts," said John Luo, MD, Assistant Clinical Professor of Psychiatry at UCLA Semel Institute for Neuroscience and Human Behavior.

The vast majority of clinicians reported recommending prescription therapies for their patients experiencing depression. Beyond pharmacotherapy and psychotherapy, 60 percent of respondents believe lifestyle changes such as diet, exercise and meditation may also be helpful in treating depression, depending on the patient’s individual situation.

Additional key survey findings include:

– Gender makes a difference when diagnosing depression

– Thirty percent of clinicians reported being less likely to discuss depression with men.

– Clinicians reported it is often more difficult to treat men because they are less "open" than women, and symptoms such as anger or addiction may not be immediately linked to depression.

– Clinicians may be more likely to experience depression

– More than 50 percent of clinicians reported experiencing depression at some point in their lives, which compared to the National Institutes of Health data, could make them more than twice as likely to experience depression as the general public.

– Additionally, 12 percent of clinicians reported missing work because they felt depressed. Clinicians are not alone-a national study revealed that depression is the leading cause of missed work days, and lost productivity due to depression is estimated at $83 billion a year.

For more about depression, including a podcast with UCLA psychiatrist Dr. Luo, clinicians’ comments and comprehensive survey results, please visit http://insights.epocrates.com/depression. Comprehensive dosing and drug interaction information for anti-depressants can also be found at http://www.epocrates.com.

I think back to some of my encounters with patients and feel lousy that I probably acted as if I were not really "there" with the patient. Even though as an ER doctor I learned to multi-task very early on, the patient never knew that I really could pay strict attention to them and what they were saying while still hearing and seeing everything that was going  on around me in the ER.

I imagine they thought I wasn't interested in them and therefore didn't think their problem was very important.  And that's not the case at all.

So, I caution people to not make snap judgments about whether your doctor is listening to you or not. You cannot really tell just based on how they do or don't look at you. On a personal note, I have to tell people I'm talking with (including my best friends) that if I'm looking away, I'm probably trying to concentrate/think and listen to a greater degree. I find that when I look at you and try to pay attention to you, I get distracted - usually by your eyes for they ARE the window to your soul and you can learn so much from someone's eyes. But, if I don't tell the other person this, they might think that my looking away is a sign of boredom. And it's just the opposite. A fine line to walk.

Use all your senses to accumulate an entire picture about what's happening with the doctor before you judge that he or she is not "interested" in you or your problem.

Terrie

Hi There,

Another fun time on the radio tonight - that’s BlogTalkRadio! We talked about several things on the show:

1) I discussed an entry from a malpractice lawyer’s blog where he said that many people call his office to discuss medical care they or a loved one received which resulted in some type of problem. Many believe that JUST because some complication occurred that the doctor or the hospital must have done something wrong and therefore they think they have a viable malpractice lawsuit.  He said that frequently the real problem is lack of good communication between the doctor and the patient (or family). Often his clients say the doctor never told them what happened or fully discussed the problems or complications. He urged patients to open a dialogue with their phyicians and ask as many questions as possible. I felt this was an excellent assessment of the communication problem we have in the U.S.

2) Then I talked about the new recommended reform from the American Academy of Family Physiicans "America’s Family Physicians Join Major Employers and Other Physicians to Revolutionize America’s Health Care System". 
“In a health care environment where there is a growing unease among patients and employers alike about the rising costs and declining quality of health care, America’s family physicians believe every patient should have a personal medical home – a trusted source of primary care,” said Rick Kellerman, M.D., President of the AAFP. 

The patient-centered medical home model promises value not only to patients but to the health care system as a whole. Unlike the current system, which rewards high-volume, over-specialized and inefficient care, the patient-centered medical home is based on the premise that the best health care has a strong primary care foundation and strives for quality and efficiency. Most importantly, it returns the focus back to the patient and is built by an ongoing relationship between a patient and his or her personal physician. 

In a patient-centered medical home:

What a terrific concept, don’t you think? Thanks to the American Academy of Family Physicians!

3) I talked about a "Clinical Empathy" (bedside manner) course being presented at the Medical College of Virginia. Empathy is what I knew as "Bedside Manner" - you know the old Marcus Welby, M.D.  This course teaches young doctors and medical students the interviewing techniques that will show the patients that they really do care and are listening to them and their problems. Unfortunately as technology advances, the interpersonal relationship between the physician and the patient suffers - to the detriment of each. Doctors do not know how to listen or talk to patients - they know how to Diagnose - that is primarily what they are taught. This is a great concept and  I certainly hope this pilot program persists.

4) Finally I shared 3 things that inhibit effective communication between physicians and patients:

• The patients are only able to spend 7-10 minutes with the doctor
• Few patients remember more than the first and last thing the doctor tells them
• Doctors do NOT know they CAN’T communicate.

 It was a fact filled night. Enjoy the replay.

Terrie

Another great show. The media player on the left sidebar seems to have the volume low. I hope it wasn’t like that on the actual show. But I have a recording here that you can play and should have better luck.

I had two terrific guests:

Dr. Signe Dayhoff is a Social Psychologist and author. A coach & trainer for over 20 years, she helps individuals struggling with self-presentation anxiety (which includes fear of small talk, stage fright, and self-promotion reluctance) to present themselves confidently and competently. She also helps you master interpersonal communication skills so you can be socially effective in almost any personal or work situation. Check out her website at http://www.effectiveness-plus.com .

My second guest was a long time friend of mine, Wendy Gelberg. She has been a career coach/advisor and resume writer since 1995, working with people at all stages in their careers and in a multitude of occupations and industries, from entry level to executives. Prior to that, she held jobs as a high school history teacher, a college instructor (educational tests and measurement), a secretary at a university, and a career coach at a career center. Her passion is teaching, in classroom/workshop settings and one-on-one, and she loves facilitating those “aha” moments when people discover information that is meaningful and helpful to them. Check her website at http://www.gentlejobsearch.com .

Both these women discussed the fact that there isn’t much difference between dealing with authority figures in everyday life  and dealing with doctors. I hope you enjoy the show.

I also mentioned two great websites that I’m going to put on the links. These are terrific patient advocate sites and have excellent information for you.

They are www.everypatientsadvocate.com and www.diagKNOWsis.com

Check ‘em out and see if they don’t give you good information.

Terrie

Here’s the show:

This is very long but well worth the read (to me anyway). Although it’s about the mental health professionals, it could certainly be applied to any physician. Know anyone who fits this bill?

This article received a Thinking Blogger Award!

 This is my proposal for the DSM inclusion of a new section that outlines and categorizes the features of Mental Health Professional Personality Disorders or MHPPDs.

This proposal begins with a general definition of Mental Health Professional Personality Disorder that applies to each of the 4 specific MHPPDs. An MHPPD is an enduring pattern of inability to empathize with or understand the inner experience and behavior of certain patient populations that deviate markedly from the MHP’s own expectations, individual culture, life experience, values, and personal lifestyle preferences. MHPPD is pervasive, inflexible, prejudicial and has an onset upon reading educational psychiatric literature, engaging in disparaging prejudicial discussion with “more experienced” colleagues, may be triggered by reading a chart with which includes a previous undesirable diagnosis for a patient, is stable over time, and leads to further distress or impairment in the condition of the MHP’s patient. The Mental Health Professional Personality Disorders included in this proposal are listed below.

Mental Health Professional Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that patients’ motives are interpreted as malevolent or manipulative.

Mental Health Professional Antisocial Personality Disorder is a pattern of disregard for and violation of the rights of patients.

Mental Health Professional Narcissistic Personality Disorder is a pattern of grandiosity, need for the compliance of one’s patients, and a lack of empathy for the experience or suffering of those patients.

Mental Health Professional Coercive Personality Disorder is a pattern of dominant and aggressive authoritarian behavior related to an excessive need to be in control of patient treatment decisions.

Mental Health Professional Personality Disorder Not Otherwise Specified is a category provided for two situations: 1) the MHP’s personality pattern meets the general criteria for an MHPPD and the traits of several different MHPPDs are present, but the criteria for any specific MHPPD are not met; or 2) the MHP’s personality pattern meets the general criteria for an MHPPD that is not included in the Classification (e.g., mental health professional passive-aggressive personality disorder). It should be noted that MHPs frequently present with co-occurring personality disorders.

More on Satire - But, Oh So True!

Great article on how to talk to your doctor about embarrassing medical problems - Dr. Vicki Rackner has the same sense of teaching patients how to take charge of their own health and care as I do - of course, she’s much younger and seemingly more energetic so Bravo to her for championing the cause! Check her out.

The realization hit Natalie like a ton of bricks. Her mother, Joann, had literally died of embarrassment! Joann had noticed blood in her stool almost a year before she was diagnosed with colon cancer. At first she told herself it must have been those beets she ate. Then she thought it was most likely her hemorrhoids, although she had not had a flair-up of hemorrhoids since Natalie’s birth 52 years earlier.

The truth was that Joann was embarrassed to talk with her doctor about private topics such as her bowel habits. She didn’t raise the concern with her doctor until she had bloating, cramping and abdominal pain. This led to the diagnosis of colon cancer that ultimately took her life. Natalie’s brother-in-law, who was a nurse, wondered whether Joann would still be alive if she had told her doctor about the blood in her stool when she first noticed it.

Let’s face it; certain topics are embarrassing to talk about with your doctor. I call them the 5 P’s:

• Peeing
• Pooping
• Paying
• Procreating
• Psychic moaning

Although at first blush the challenge of talking with your doctor about embarrassing medical topics seems simple enough, for some people, it can cause significant suffering.

Hillary, for example, had what’s now called a shy bladder. She had not used a public restroom in over 20 years. She was too embarrassed to talk with her doctor about this; instead, she remained a prisoner to her bladder.

Ed was laid off from work and could no longer afford his asthma medications. Instead of talking with his doctor about it, he decided to do without He wound up in the emergency room with an asthma attack that could have been avoided with regular medication.

Tom had some sexual side effects from his blood pressure medicine. Instead of talking with his doctor and getting a different medicine, he just stopped taking it. The doctors wonder if this might have contributed to his heart attack.

Jerry noticed his loss of appetite and sleeping problems as his caregiver responsibilities for his aging father mounted. He wondered if he might be depressed, but dismissed the thought because real men don’t get depressed.

Imagine how each of these stories might have been different if these individuals who suffered in silence could have talked with their doctors.

Here are 6 tips that can help you talk with your doctor about embarrassing medical topics:

1. Own the embarrassment.

Say to your doctor, “This is a taboo topic in our family, so it’s hard for me to ask. Is it normal to have a funny smell coming from your belly button?"

2. Find the words.

Your doctor speaks a specialized language acquired through years of training. Sometimes patients are embarrassed because they don’t know the “right words" or have a hard time describing the problem.

Remember that your job is to communicate. You don’t need to know the fancy words to do that. If a patient said to me, “Dad had an operation on the dingle-ball thing at the back of his throat", I would know just what he meant. And, the patient would seem relieved when I said, “Oh, you mean the uvula."

The best way to make sure you and your doctor understand each other is to use anatomically correct words. Get a basic anatomy atlas. Use anatomically correct words with your children.

3. Practice saying the words.

Sometimes embarrassing words can be hard to get out of your mouth. Gertrude, a 90-year-old patient said to me, “You youngsters don’t understand how much things have changed. When I got breast cancer in the 1962, the words ‘breast’ and ‘cancer’ were not uttered in polite company." Some words are still embarrassing to say. Practice saying these words out loud when you’re alone! That will make it easier to say them at the doctor’s office

4. Find the right person to ask.

You may have an easy rapport with the nurse or physician’s assistant at your doctor’s office. You can bring up the sensitive topic with them. Say, “Trish, could you please give the doctor a heads up. I want to know why I should say no to those steroids my buddies at the gym are offering me. I would love to look like they do."

5. Find the right way to ask.

Maybe it’s easier for you to drop a note or a cartoon to your doctor rather than ask in person. Find the style that works best for you.

6. Remember that your doctor is there to help you, not to judge you.

Your doctor has heard it all before. I promise! Your doctor will not think less of you for asking an embarrassing medical question; in fact, your doctor with think more of you for overcoming your fear and helping you take charge of your health.

Dr. Vicki is a board-certified surgeon who left the operating room to help families take the most direct path from illness to optimal health. Her book, “The Personal Health Journal", can save your life today by helping you understand your health story. Empower yourself with the tips and tools that will help you direct your story and partner with your doctor more effectively at: http://www.drvicki.org/drvicki-store-health-journal.html 

Great article on how to talk to your doctor about embarrassing medical problems - Dr. Vicki Rackner has the same sense of teaching patients how to take charge of their own health and care as I do - of course, she’s much younger and seemingly more energetic so Bravo to her for championing the cause! Check her out.

The realization hit Natalie like a ton of bricks. Her mother, Joann, had literally died of embarrassment! Joann had noticed blood in her stool almost a year before she was diagnosed with colon cancer. At first she told herself it must have been those beets she ate. Then she thought it was most likely her hemorrhoids, although she had not had a flair-up of hemorrhoids since Natalie’s birth 52 years earlier.

The truth was that Joann was embarrassed to talk with her doctor about private topics such as her bowel habits. She didn’t raise the concern with her doctor until she had bloating, cramping and abdominal pain. This led to the diagnosis of colon cancer that ultimately took her life. Natalie’s brother-in-law, who was a nurse, wondered whether Joann would still be alive if she had told her doctor about the blood in her stool when she first noticed it.

Let’s face it; certain topics are embarrassing to talk about with your doctor. I call them the 5 P’s:

• Peeing
• Pooping
• Paying
• Procreating
• Psychic moaning

Although at first blush the challenge of talking with your doctor about embarrassing medical topics seems simple enough, for some people, it can cause significant suffering.

Hillary, for example, had what’s now called a shy bladder. She had not used a public restroom in over 20 years. She was too embarrassed to talk with her doctor about this; instead, she remained a prisoner to her bladder.

Ed was laid off from work and could no longer afford his asthma medications. Instead of talking with his doctor about it, he decided to do without He wound up in the emergency room with an asthma attack that could have been avoided with regular medication.

Tom had some sexual side effects from his blood pressure medicine. Instead of talking with his doctor and getting a different medicine, he just stopped taking it. The doctors wonder if this might have contributed to his heart attack.

Jerry noticed his loss of appetite and sleeping problems as his caregiver responsibilities for his aging father mounted. He wondered if he might be depressed, but dismissed the thought because real men don’t get depressed.

Imagine how each of these stories might have been different if these individuals who suffered in silence could have talked with their doctors.

Here are 6 tips that can help you talk with your doctor about embarrassing medical topics:

1. Own the embarrassment.

Say to your doctor, “This is a taboo topic in our family, so it’s hard for me to ask. Is it normal to have a funny smell coming from your belly button?"

2. Find the words.

Your doctor speaks a specialized language acquired through years of training. Sometimes patients are embarrassed because they don’t know the “right words" or have a hard time describing the problem.

Remember that your job is to communicate. You don’t need to know the fancy words to do that. If a patient said to me, “Dad had an operation on the dingle-ball thing at the back of his throat", I would know just what he meant. And, the patient would seem relieved when I said, “Oh, you mean the uvula."

The best way to make sure you and your doctor understand each other is to use anatomically correct words. Get a basic anatomy atlas. Use anatomically correct words with your children.

3. Practice saying the words.

Sometimes embarrassing words can be hard to get out of your mouth. Gertrude, a 90-year-old patient said to me, “You youngsters don’t understand how much things have changed. When I got breast cancer in the 1962, the words ‘breast’ and ‘cancer’ were not uttered in polite company." Some words are still embarrassing to say. Practice saying these words out loud when you’re alone! That will make it easier to say them at the doctor’s office

4. Find the right person to ask.

You may have an easy rapport with the nurse or physician’s assistant at your doctor’s office. You can bring up the sensitive topic with them. Say, “Trish, could you please give the doctor a heads up. I want to know why I should say no to those steroids my buddies at the gym are offering me. I would love to look like they do."

5. Find the right way to ask.

Maybe it’s easier for you to drop a note or a cartoon to your doctor rather than ask in person. Find the style that works best for you.

6. Remember that your doctor is there to help you, not to judge you.

Your doctor has heard it all before. I promise! Your doctor will not think less of you for asking an embarrassing medical question; in fact, your doctor with think more of you for overcoming your fear and helping you take charge of your health.

Dr. Vicki is a board-certified surgeon who left the operating room to help families take the most direct path from illness to optimal health. Her book, “The Personal Health Journal", can save your life today by helping you understand your health story. Empower yourself with the tips and tools that will help you direct your story and partner with your doctor more effectively at: http://www.drvicki.org/drvicki-store-health-journal.html