Stress Management

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Manage your thoughts

  • Know the main issues with your patients and anticipate problems that may arise including non-response to treatment
  • Have previously rehearsed strategies to deal with undifferentiated or defined problems
  • Understand the thought processes of your seniors when they launch into a set of investigations or management strategy
  • See patterns in your tasks
  • Rehearse your referrals / discussions before calling someone so it is clear and succinct.  Learn to get to the point
  • Memorise the hospital Emergency number
  • Memorise MET criteria
  • Know how to deal with common emergencies and drug doses e.g. anaphylaxis, dyspnoea, shock, oliguria, seizures, agitation, altered conscious state, coma
  • Be familiar with the common conditions and treatments/procedures on your unit
  • Always think ‘have I not considered something?’, ‘Is there something I haven’t done?’, ‘What happens if this doesn’t work out?’
  • Regularly get informal feedback from your seniors to recalibrate expectations.  ‘How am I doing’, ‘Is there anything I do better?’, ‘What do you suggest would help me?’

Manage your skills

  • Be efficient and proficient at common tasks e.g. venipuncture, IV access, ABG, NGT, IDC
  • Refresh your BLS skills

Managing your time

  • Anticipate tasks before you are asked
  • Order bloods tests, discharge scripts the evening before.
  • Finalise discharge summaries before day of discharge
  • Anticipate the type of information required that will influence patient management and disposition
  • Be prepared for important questions and decisions during the ward round
  • Promptly instigate requests that require time to mobilise – e.g. ward consults, imaging requests, respite care, transport home
  • Develop routines to deal with common scenarios
  • Check results at the end of the day and keep seniors aware of significant changes or evidence of improvement
  • Complete fluid orders and drug chart rewrites at the end of the day for the next 24 hour period

Manage your information

  • Make a ready reference of cheat sheets – ward protocols, clinical guidelines, drug doses, therapeutic regimes.  Begin memorising them
  • Keep a list of important phone numbers – consultants mobile, registrars pager, lab and imaging results,  radiology registrar, transfusion lab, HDU, ICU. theatre, anaesthesia registrar, ICU consults, PICC lines, theatre bookings, ward clerk, CSC etc
  • Keep Important patient details, labs and imaging together
  • Have patient’s results, nursing chart and case notes in front of you when you make a referral

Manage your team – i.e. seniors, nurses, allied health etc

  • Know your team members by name
  • Learn to communicate succinctly, effectively and respectfully with your team
  • Keep your team regularly abreast of your patients’ condition and your thought processes
  • Listen carefully to concerns, advice or suggestions and consider them appropriately
  • Get assistance promptly if you are unsure of something
  • Anticipate the needs and routines of your team.  Don’t interrupt unnecessarily or let your disorganisation become a burden to others.
  • Learn to deal with conflict professionally
  • Learn to co-ordinate your team and capitalise on their strengths.
  • Don’t delegate inappropriately or recklessly

Manage your bedside manner

  • Apply everything as above with your patient and their relatives

Manage your social supports

  • Maintain contact with your peers
  • Make time for family

Manage your emotions

  • Allocate time to regularly debrief about the day/week/month with a sympathetic ear
  • Recognise when you are being pre-occupied with unproductive thoughts/feelings
  • Learn to take ‘time out’ to gather yourself together

Manage your ‘outside time’

  • Learn to ‘have fun’
  • Make time beyond work
  • Don’t ‘hover’ around at work once it is finished
  • Stay physically healthy – diet, exercise
  • Keep or start a manageable hobby

Common sources of stress for the ‘doctor in difficulty’

  • Sketchy clinical knowledge > unfocussed clinical assessments
  • Haphazard clinical skills > missed critical clinical signs
  • Lack of practical application of knowledge and skills > inability to prioritise or identify key issues
  • Unsystematic approach to problem-solving > incomplete assessments
  • Lack of practise with procedural skills > time wasting
  • Poor organisation > tasks not completed in time, frustrated colleagues
  • Poor communication > frustrated and angry team members, colleagues, patients and relatives
  • Isolationism > pent-up stress

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