Tuesday, September 12, 2006

stress management : For Patient and Physician

Stress is the most common cause of ill health in our society, probably underlying as many as 70% of all visits to family doctors. It is also the one problem that every doctor shares with every patient. This presents physicians with two advantages:
It is an issue we can relate to experientially so we can use ourselves as a reference point.
In studying and better understanding stress, we can derive personal as well as professional benefits.
As my mentor, Dr. Matthew Budd of Harvard University, told me at our first meeting in 1982, "If you want to help your patients deal with their stress, you're going to have to learn to handle your own." Therefore, when I talk to physicians, I invite them to listen on two channels: one for their patients and one for themselves. The material is much more meaningful if you can connect with it on a personal level.

The manifestations of stress are legion. Early in this century, medical students were taught that, "if you know syphilis (the great masquerader), you know medicine." One could say the same about stress. It can contribute to or mimic just about any symptom you can think of. However, the main presentations can be summarized under four headings: physical, mental, emotional and behavioral (see Patient Information sheet.)

The causes of stress are multiple and varied but they can be classified in two general groups: external and internal. External stressors can include relatives getting sick or dying, jobs being lost or people criticizing or becoming angry. However, most of the stress that most of us have is self-generated (internal). We create the majority of our upsets, indicating that because we cause most of our own stress, we can do something about it. This gives us a measure of choice and control that we do not always have when outside forces act on us.

This also leads to my basic premise about stress reduction: to master stress, you must change. You have to figure out what you are doing that is contributing to your problem and change it. These changes fall into four categories: change your behavior, change your thinking, change your lifestyle choices and/or change the situations you are in. By getting to the root causes of your stress, you can not only relieve current problems and symptoms but you can also prevent recurrences. For example, if you keep becoming frustrated over arguments with your children, you might discover that the cause of your upset is not their behavior but your unrealistic expectations. By modifying your standards, you might find the children's actions no longer bother you.

There are many ways to relieve stress, from going for a walk to quitting your job. What follows is a list of 10 practical and down-to-earth strategies which I have found helpful over the years for both myself and my patients. Some are simple and can be implemented quickly; others are a bit more involved. All are feasible and beneficial.

copyright © 1995-2005 by Phillip W. Long, M.D.

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