How physicians can better deal with their stress

BY KATHY HAGOOD

            One physician practices yoga to de-stress, another one reads, yet another spends 30 minutes each day praying and meditating. All swear by cardio workouts, a balanced diet, and spending time with family and friends.
            While these North Florida doctors keep stress at bay with healthy habits, others seek comfort in hefty doses of the very things that make their stress worse: high-fat and sugary foods, coffee, alcohol, cigarettes and the couch.
            “Drinking can become a favorite way to address stress. Like anyone else, when physicians become overwhelmed they tend to eat junk food, stop exercising and turn to addictions,” said Michael Solloway, M.D., medical director of behavioral health services at Baptist Behavioral Health in Jacksonville.
            Such bad habits can lead to metabolic syndrome, an interrelated set of conditions - including high blood pressure, elevated insulin levels, excess body fat and elevated cholesterol levels - that can increase one’s risk for heart disease, stroke and diabetes.
            February, Heart Month, is a good time for all doctors to take a hard look at what strategies they use to de-stress to make sure they’re keeping their heart healthy.
            “If you’re falling into bad habits, it’s better to catch yourself sooner rather than later,” Solloway said. “And if you find you’re experiencing a prolonged period of depression or anxiety that makes it difficult or impossible to maintain healthy habits, you need to reach out for help."
            Medication, psychological counseling or a combination of the two may be all that’s needed to set a troubled physician, who may have a genetic predisposition to depression and anxiety, on the right path again.
            “Physicians may be reluctant to seek psychiatric help when they need it because they feel they must maintain their position as the authority figure. But a simple office visit can change their life for the better,” Solloway said. 
            Making life and death choices and decisions that significantly affect a patient’s health can be nerve-racking. Some specialties, including emergency medicine and surgery, have the potential for more stress than others. Few things are more upsetting than being sued for malpractice.
            “There are multiple stressors in medicine.  The culture of medicine has radically changed. Physicians are pressed to see so many patients these days, plus we have high standards for ourselves. We’re pulled in so many directions with financial and legal issues, and then there’s the paperwork,” said Dr. Mark McIntosh, University of Florida College of Medicine Jacksonville associate professor and director of integrated medicine.
            McIntosh is the UF wellness guru at Shands Jacksonville and leads seminars to help residents recognize their stress reactions and use healthy habits to buffer it. He points to studies that show high depression and burnout rates among physicians, and says doctors must be on guard against that.
            “When you’re burned out because you haven’t taken care of yourself, you have less empathy, you don’t get the story from the patient,” McIntosh said. “To balance your life and effectively care for patients, you have to care for yourself.”
            In addition to exercise and a healthy diet, McIntosh centers himself and de-stresses by spending 30 minutes every day in prayer and meditation.
            “Everyone needs to find their own way of getting centered. What works for one person may not for another. We’re all individual,” McIntosh said.
            Laura Vallon, M.D., a radiation oncologist with the Mayo Clinic in Jacksonville, found her way after she took a Hatha Yoga class two years ago from instructor Didier Razon.
            “I knew after the first class it was the perfect exercise for me,” said Vallon, who also runs.
            And not only was yoga good exercise, it also changed her life, she said, allowing her to better face the responsibility of making treatment decisions for cancer patients and be a better parent.
            “I’ve learned how to relax and turn my mind off, to be silent and present. It’s improved every aspect of my life,” she said.
            Vallon encourages other physicians to keep searching until they find the thing or things that relax and refresh them.
            “It should be something you look forward to, not an obligation,” Vallon said.
            Dr. Richard Stromberg, M.D., chief of emergency medicine at Baptist Medical Center, finds urgent care invigorating and challenging vs. stressful, but does admit his job, like any physician’s, has its frustrations.             
            “Because of my personality type I would find a less intense specialty more stressful because I would be bored,” he said.
            Stromberg uses a variety of strategies to balance his life outside of work and renew himself so he’s able to face the life and death challenges of the emergency room. He makes it a priority to have dinner with his family.
            “It may not sound like much but it’s the most helpful thing for me. I tell them what I did that day and they nod and act interested,” Stromberg said laughing.
            Stromberg also enjoys playing golf and traveling. He and his wife have traveled across the United States, Europe and South America. They soon will be heading off to India on vacation.
            “For myself I try to remember work is business and not my life,” Stromberg said.
            Michael S. Nussbaum, M.D., F.A.C.S., professor and chair of the department of surgery at UF, also finds vacation time to be an antidote to stress. He and his family recently stayed the weekend at Amelia Island.
            “It was great to spend time with my family and I came back completely refreshed,” he said.
            In addition to his clinical practice, in which he focuses on non-invasive gastrointestinal surgery, Nussbaum administers a medical department with 40 faculty members and several hundred employees and residents.
            “My job definitely has its stresses, so I take time to relax,” said Nussbaum, who moved to Jacksonville from Cincinnati, Ohio, earlier this year.
            Nussbaum starts his day off by getting up early and running. He’s currently training for a marathon in July. He listens to books on his Ipod while he’s running.
            “Reading relaxes me, and I’m an avid reader, so listening to a book while I’m running is a great combination,” he said.
            Nussbaum is such a book fan that he’s a member of the Cincinnati Literary Club, founded in 1849, which is limited to 100 invited members. The elite club has been visited by several presidents and such notables as Mark Twain and Robert Frost.
            “It’s something I still keep up with,” Nussbaum said.
            In addition to such R&R strategies to manage stress, Solloway also suggests physicians can lessen their stress by cultivating a flexible attitude and sense of humor.
            “When it comes to things like new rules and regulations, it’s best not to take them personally. Things are always changing, and if your expectations are out of line with reality, you’re going to be disappointed,” Solloway said.