In our previous article, we talked about the psychological responses that can arise when faced with the stress of ‘difficult consultations'. In this article, we will focus on the use of psychological strategies to protect the self when faced with a climate of ever-increasing demands.
So why protect the self? Robert Wicks presents a very clear rationale, "The self is limited. It has only so much energy. If it is not renewed, then depletion will take place. Too often we don't avail ourselves of the type of activities that truly renew us. When this occurs we run a greater risk that we will unnecessarily lose perspective and burn out, which is not only sad for us but for the people we are in a position to help in our circle of family, friends and co-workers"(2006). The body of research from neuroscience confirms what clinicians know all too well – that the presence of emotions such as anxiety and stress can affect cognitive processes such as reflection and mentalisation. The latter are essential components of the doctor-patient relationship and subsequent treatment planning. Finally, the rather cold financial argument is that data from the RCGP (2010) indicate that it costs £344,728 to train a GP – therefore, GPs are expensive resources and need looking after!
It is well recognised that the current working climate means that doctors are vulnerable to a range of clinical problems including alcohol, depression andmarital problems. There are several organisations that are able to help doctors in difficulty, and a list can be found on the BMA website (www.bma.org.uk). However, our approach advocates protective strategies to preventdistress and the escalation of psychological difficulties for individuals and practice teams.
Understanding the dynamics in a doctor-patient consultation or a colleague-colleague interaction enables the clinician to identify ‘exits'. Depending on the specific situation, clinicians can balance two broad psychological approaches of ‘Acceptance' and ‘Change'.
Acceptance: It is sometimes the case that an attempt to change the source of the stress is not immediately possible, and continued efforts to effect change simply result in an increase in stress, rather than a decrease. Acceptance-based strategies (such as mindfulness practice) promote an increased capacity to ‘accept' or ‘sit with' the stress and challenge without involuntary emotional reactions or judgments. In addition, such strategies emphasise validation of ourselves and our colleagues, searching for the wisdom in reactions and decisions. In this way, acceptance can be seen as a nurturing strategy, designed to increase the clinician's emotional resources in order to make changes when these are possible.
Change: Stress management strategies promote self-care by focusing on physical health such as the importance of sleep, regular eating, exercise, leisure activities and pacing. In addition, clinicians can use key psychological skills from Cognitive Behavioural Therapy (CBT) and Solution Focused Therapy (SFT). Examples include monitoring the tendency to ruminate, noticing unhelpful or rigid cognitive patterns, searching for evidence to challenge emotionally-driven conclusions, or actively identifying exceptions to problems that seem irresolvable.
We recognise that there is no one model to practice self-care. This will depend on your personal history and current needs, in the context of your home/work life. Such individual differences will define the substance and process of self-care.
It is often reported that there is little opportunity to practice them when the pressure rises. Some practice teams have decided to take a proactive approach and incorporate these activities into their core values and priorities in their mission statement. It is very difficult to promote and foster healthy individuals in unhealthy environments. In our final article, we will discuss psychological strategies to promote effective and efficient team functioning.
Dr Louise Robb and Dr Anna Gough are chartered clinical psychologists, and Naomi Jefferies chartered occupational psychologist with Apex Psychology Services
