Stress level

[Migmig]

Medical students/residents/staffs, on a scale of 1 to 10 how much work/study related stress do you have to deal with on a daily basis? Has it changed throughout time?

And how do you try and manage that stress?

It would also be nice to mention your specialty, if you have any.

[JohnGrisham]

At the Medical student level its really only stressful around exam times, the rest is just continued business not really different than a full-time career job.

[Birdy]

Currently, absolutely 0 but I’m on mat leave. 

There have been a few periods here and there when things have been rough, but the overall trend has been that I haven’t found my training terribly stressful. It’s been quite enjoyable for the most part. Good time management goes a long way, and keeping going with your life outside of medicine as much as possible. 

I’m someone who thrives with a lot to do, though. Everyone else seems to think I’m busier than I feel like I am. I’m a family med resident, though as I said I’m currently on leave so only had a few months before I was off. 

[NLengr]

I'm staff in a surgical specialty at a rural secondary care hospital. 

I'm back in my hometown with my family this weekend so zero stress except when I think about having to return to the town where I work (my family will come back with me).

Unlike residency, where lack of control and study stress dominated your life, I find my biggest sources of stress now are:

1. Hospital administration, especially non physician admin. Most of them are terrible managers and make decisions that make no sense from a financial and/or management POV. They do make lots of sense from a personal feelings, petty politics or plain old "I have no idea what I am doing" POV. They have also taken actions in the past which directly effect me or my patients without asking my opinion before taking the actions, or informing me that the action has been taken once it occurs. 

2. Nursing, specifically OR nurses. Generally the floor nurses are ok. Our OR is a cesspool of pettiness and gossip between the nurses. They continually want to be off early to the point they will start asking why we aren't done yet, even if I have two or three hours left in my day. A few of them will argue with me about why I am doing something despite it being well backed with evidence or it being the standard of care. After I explain the logic and evidence to them, they will continue to argue with me that they are right (example: I had a post op guy in DTs. I had him on ETOH withdrawal protocol, which at our center uses Ativan. One of our OR nurses told me it was more effective just to give him beer to treat his DTs. I explained that ativan is a drug with well understood metabolism, a controlled dose and is the standard of care.  I also explained that the patient had an ileus and couldn't drink a bunch of beer without puking it back up. Even after this, the nurse continued to argue with me that she was right). Don't get me wrong, we have some good OR nurses, but the place stresses the hell out of me lately. 

3. Living in the town we live in. This town is shit and myself and my spouse hate it.

[Edict]

As a resident, study related stress is minimal. Its work related, admin related duties that become big stressors. 

[NLengr]

35 minutes ago, Edict said:

As a resident, study related stress is minimal. Its work related, admin related duties that become big stressors. 

This is totally program and year dependent imo. The last 2 years of my specialty were/are study related hell. I got hypertensive from stress in my 5th year. Plus you deal with the normal residency stress. 

[Edict]

Just now, NLengr said:

This is totally program and year dependent imo. The last 2 years of my specialty were/are study related hell. I got hypertensive from stress in my 5th year. Plus you deal with the normal residency stress. 

Yes, very program and year dependent. To answer OPs question, I think the stress in pre-clerkship is low, gets worse in clerkship, tapers at the end of clerkship, starts again in residency and until you decide to choose a chill path, remains stressful until you retire. 

What stresses you changes and it is very dependent on person and on what path you want to take. The stress experienced by a plastics gunner wanting a certain program, or someone undecided between 2-3 specialties nearing CaRMS is going to be different from the stress of someone who wants family and is open to location. Similarly, the resident who wants to become a superstar, is probably going to take on a lot of added roles that will be more stressful to them than someone who is happy to plod along. Additionally, stress as we all know varies person to person, what totally stresses one person out may not stress another at all. 

 

 

[NLengr]

I'd say the royal college exam year is universally stressful. At least I don't know anyone who didnt find it extremely stressful. 

[ellorie]

Overall I find residency (pre-PGY5) to be far more pleasant than medical school.  You have some autonomy, you get paid, and you're not studying all the time for useless exams that are unrelated to your interests.

I found PGY1 stressful due to the rotating nature.  We are luckier than most in psychiatry because after PGY1 we stay in the same place for 6 months to 1 year at a time.  Once I moved off the block system my stress level decreased substantially.  Also, we don't do any more off-service after PGY1 and that helped exponentially too.  I hated being off service.

The major things that stress me out now are call (more physically than anything, I just find it's taking a bigger toll on my body as I get older/do it for longer) and patient-related stress.

And obviously now starting to stress about the exam and job-finding and stuff.

[Migmig]

3 hours ago, NLengr said:

I'm staff in a surgical specialty at a rural secondary care hospital. 

I'm back in my hometown with my family this weekend so zero stress except when I think about having to return to the town where I work (my family will come back with me).

Unlike residency, where lack of control and study stress dominated your life, I find my biggest sources of stress now are:

1. Hospital administration, especially non physician admin. Most of them are terrible managers and make decisions that make no sense from a financial and/or management POV. They do make lots of sense from a personal feelings, petty politics or plain old "I have no idea what I am doing" POV. They have also taken actions in the past which directly effect me or my patients without asking my opinion before taking the actions, or informing me that the action has been taken once it occurs. 

2. Nursing, specifically OR nurses. Generally the floor nurses are ok. Our OR is a cesspool of pettiness and gossip between the nurses. They continually want to be off early to the point they will start asking why we aren't done yet, even if I have two or three hours left in my day. A few of them will argue with me about why I am doing something despite it being well backed with evidence or it being the standard of care. After I explain the logic and evidence to them, they will continue to argue with me that they are right (example: I had a post op guy in DTs. I had him on ETOH withdrawal protocol, which at our center uses Ativan. One of our OR nurses told me it was more effective just to give him beer to treat his DTs. I explained that ativan is a drug with well understood metabolism, a controlled dose and is the standard of care.  I also explained that the patient had an ileus and couldn't drink a bunch of beer without puking it back up. Even after this, the nurse continued to argue with me that she was right). Don't get me wrong, we have some good OR nurses, but the place stresses the hell out of me lately. 

3. Living in the town we live in. This town is shit and myself and my spouse hate it.

So you're saying the stress is not about the job itself, but more about the settings of the job, right? 

[Migmig]

2 hours ago, Edict said:

As a resident, study related stress is minimal. Its work related, admin related duties that become big stressors. 

What are some examples of work related stress, if you don't mind. 

Are they in general better or worse than study related stress?

[indefatigable]

My example isn't applicable to anyone really, but I did find my first year of med school to be incredibly stressful.  I started studying in a second language environment, for which I lacked sufficient foundations for med-school level difficulty and intensity.  The level of effort that I put in was incredibly high, but the results weren't at all impressive.  Gradually, over time, things have improved, although unfortunately it's still a notable disadvantage even today.  Nonetheless, I've been able to add a bit of balance which has made things easier.  I did have a longer road to medicine having done a PhD, post-doc and other academia, so I had some experience in  diverse challenging experiences, but I did find a language barrier to be one of the most difficult obstacles to overcome, for sure.  I'm not sure if anything will ever come close to that experience.          

[Edict]

5 hours ago, Migmig said:

What are some examples of work related stress, if you don't mind. 

Are they in general better or worse than study related stress?

You might have to deal with long hours compounded by interpersonal conflicts, hospital politics, problems with the team, patient conflicts. Personally, I think study related stress is easier to handle because it is predictable, but this varies by person.  

 

Whether or not residency or med school is more challenging varies by person because everyone comes to medical school and residency with a different background, circumstances etc. There isn't a definitive answer to this question. Someone for whom finances are a challenge may find medical school more of a challenge for example.

Generally things tend to be more stressful when your future is uncertain and you have to put in extra effort to secure your designed goal, i.e. the year prior to CaRMS, the year prior to your RC, the year prior to applying to med school, Grade 11. Things tend to be better when you have gotten in, but haven't actually had to make that transition i.e. a successful match post-CaRMS, after getting into med but before starting, senior year second semester aka senioritis. 

[ACHQ]

9 hours ago, NLengr said:

I'd say the royal college exam year is universally stressful. At least I don't know anyone who didnt find it extremely stressful. 

As someone with their royal college exam this year.... this x 10.

[goleafsgochris]

Neurologist who does 90% outpatient work, finished residency in 2017.

My day to day job now is not stressful.  I sometimes find it stressful if I'm falling behind in the day and am late seeing patients, but that's like a 2/10.  I would agree that conflicts with staff can be somewhat stressful, but at least in my case, this is very minimal.  

I do a week of call and see hospital consults every 2-3 months.  Ive heard others find this week to be very stressful.  For me, its so much less call than I did as a resident that I find it almost enjoyable to get some variety.  That being said, the nights and need to make decisions on more serious cases is MORE stressful, maybe a 3/10 for this?

PGY-5 with the exam was a 10/10 stress, for sure.  That was the most stressed I was in any year of my life, including med school and undergrad.  

[MSWschnoodle]

On 10/27/2018 at 5:25 AM, NLengr said:

One of our OR nurses told me it was more effective just to give him beer to treat his DTs. I explained that ativan is a drug with well understood metabolism, a controlled dose and is the standard of care.  I also explained that the patient had an ileus and couldn't drink a bunch of beer without puking it back up. Even after this, the nurse continued to argue with me that she was right).

This... is horrifying. 

Also... where the heck is this nurse getting beer in the hospital?! o_O 

[NLengr]

27 minutes ago, MSWschnoodle said:

This... is horrifying. 

Also... where the heck is this nurse getting beer in the hospital?! o_O 

Pharmacy stocks beer. Shitty labatt beer, but beer none the less. Every hospital I worked at had beer on stock.

[ploughboy]

On 10/27/2018 at 7:25 AM, NLengr said:

example: I had a post op guy in DTs. I had him on ETOH withdrawal protocol, which at our center uses Ativan. One of our OR nurses told me it was more effective just to give him beer to treat his DTs.

Yikes.

I'm curious.  What part of the early 20th century is your hospital located in?

[ploughboy]

On 10/27/2018 at 9:29 AM, NLengr said:

I'd say the royal college exam year is universally stressful. At least I don't know anyone who didnt find it extremely stressful. 

Worst year of my life.

[NLengr]

1 hour ago, ploughboy said:

Yikes.

I'm curious.  What part of the early 20th century is your hospital located in?

1800s. 

To be honest, some of the OR nurses are quite a few cards short of a deck in the intelligence department. 

[Migmig]

14 hours ago, goleafsgochris said:

That being said, the nights and need to make decisions on more serious cases is MORE stressful, maybe a 3/10 for this?

Wow, you look very zen to me! for me, nights and making life changing decisions would be 11/10 (at least that's what I assumes! haven't been in the situation so far). Do you mind sharing some of the methods for managing the stress, if you have any?

[A-Stark]

I'm only a few months in but I do find staff life more stressful. The exam year was a different kind of crazy but I find outpatient practice dizzying. My setup is pretty nice and our EMR is good, but it tends to pull me in many different directions at once. The ICU weeks are busy and often long but my days are much more circumscribed. 

Call is busy but I don't find it stressful exactly. Tiring, for sure, but that's not quite the same. I also live within walking distance to the hospital so it's enough getting around. (It's really been far more stressful going through kitchen renos...)

On 10/27/2018 at 8:55 AM, NLengr said:

2. Nursing, specifically OR nurses. Generally the floor nurses are ok. Our OR is a cesspool of pettiness and gossip between the nurses. They continually want to be off early to the point they will start asking why we aren't done yet, even if I have two or three hours left in my day. A few of them will argue with me about why I am doing something despite it being well backed with evidence or it being the standard of care. After I explain the logic and evidence to them, they will continue to argue with me that they are right (example: I had a post op guy in DTs. I had him on ETOH withdrawal protocol, which at our center uses Ativan. One of our OR nurses told me it was more effective just to give him beer to treat his DTs. I explained that ativan is a drug with well understood metabolism, a controlled dose and is the standard of care.  I also explained that the patient had an ileus and couldn't drink a bunch of beer without puking it back up. Even after this, the nurse continued to argue with me that she was right). Don't get me wrong, we have some good OR nurses, but the place stresses the hell out of me lately. 

I never got the "leaving early" thing. Why would they ever get to do that? There'd certainly be time for an extra case or so if that policy didn't exist. 

Otherwise they never had any sense to NOT trash talk each other while other people are sitting in, say, patient holding. (Other people as in me.)

[NLengr]

7 hours ago, A-Stark said:

 

I never got the "leaving early" thing. Why would they ever get to do that? There'd certainly be time for an extra case or so if that policy didn't exist. 

Otherwise they never had any sense to NOT trash talk each other while other people are sitting in, say, patient holding. (Other people as in me.)

I have no idea why they are allowed to leave early if everything is done and yet they still seem to get paid till 4. They should have to be in the hospital till 4 no matter what. There is always something that could be found to do. I think it's because the OR nursing admin is super weak and more concerned about being liked than being a good manager. 

 

Yeah the gossip is brutal and they all trash talk each other behind each others backs constantly. The thing is, they all love doing it, they all know it happens and it's accepted as normal behaviour amongst the OR nurses. It's crazy but given the fact the entire town is a giant mill of gossip, jealousy and pettiness, it's not surprising.

 

As for why they don't have the common sense to not do it around other people it's a simple answer: A surprising amount of them don't have it at all.

[NLengr]

8 hours ago, A-Stark said:

I'm only a few months in but I do find staff life more stressful. The exam year was a different kind of crazy but I find outpatient practice dizzying. My setup is pretty nice and our EMR is good, but it tends to pull me in many different directions at once. The ICU weeks are busy and often long but my days are much more circumscribed. 

Call is busy but I don't find it stressful exactly. Tiring, for sure, but that's not quite the same. I also live within walking distance to the hospital so it's enough getting around. (It's really been far more stressful going through kitchen renos...)

You'll find that it takes a bit of time (6-10 months) to really settle into outpatient stuff and get a good system going. But it will happen eventually and things become easier. 

I found by the one year mark a few months ago my efficiency had improved so much that I only took 2/3 of the time to see a new consult as I did when I started. And by a year in I had a good system developed for triage and running my day to day life. 

I talked to many others I knew in my specialty (in the province and in other provinces) about how they did things from a practice management point of view. I then cherry picked the best parts and copied them in my own practice. That was my smartest move I think.