Physician Stress Management Tips for Enhanced Performance

1. Stress Management for Physicians  David R. DeMaso, MD Director, Office of Clinician Support Psychiatrist-in-Chief & Chairman of Psychiatry, Children�s Hospital Boston Professor of Psychiatry (Pediatrics), Harvard Medical School

5. Distress Can Exact A Toll On Body & Mind Can be useful in enhancing performance & efficiency Can be harmful & negative especially when it becomes chronic & excessive

6. The Classic Negative Stress Cycle

8. Stress Management �Seeing the Light� Take out one or two things reduces stress No need to remove all Just a few minutes can make it better Simple step Tough to sell

9. Interventions to Consider

10. Time Management Manage in the customer rush�avoid harried look�make eye contact�sit down�saves time later Set up boundaries from the beginning Whether in your handling e-mail, voice-mail, or telephone calls (i.e., review specific times & ways managed) Calendar�use only one�write down firm commitments�check daily�schedule all your time (specifically personal & professional) Set your priorities in �to do� lists Daily to-do list is�rewritten or added to many times a day�filled with quick items�out for quick reference Master list is something that grows slowly�not daily�filled with longer bigger tasks�often posted on the wall Break projects up into 30-minute segments Schedule 30 minutes/day in your calendar to work on "important but not urgent"�

11. E-Mail & Meeting Management Manage your E-mails Consider set reading times Few words�keep your outgoing messages concise Decide your boundary related to patient care Do not over stimulate�meaning minimize contact Emotions do not travel well in written form�humor or sarcasm might not come across�No personal allusions Not paid as in private sector Manage your meetings Set agenda Set leader Set time (Ii.e., Does it need to be 1 hour?) Stay on task

12. Personal Management Time with someone or something other than work-related during course of day Clinical & research work is isolating & generally overpowers one�s own professional (i.e, research/writing) and personal needs Break from exposure to serious tragedy In England, it�s a �consultation with Dr. Brown� Need only be a few minute to interrupt burdens Time outside of work (i.e., scheduled exercise, movie, hobby, etc.)

14. Remember what keeps you here�What is good about being here� Where do you want to be in 5 years? Avoid tendency of not seeing anything positive. When under stress focus is on the negative & the moment. Emans 24-hour Rule: Take 24 hours to reflect before deciding Remember your long-term goals & plans: Aim for them.

15. Personal Management Two Anti-Stress Onsite Approaches 4-Steps to Interrupting Stress Relaxation Response

17. Interrupting Stress � A 4 Step Approach Stop Each time you encounter a stress�stop�before (automatic) thoughts escalate into worst possible scenarios. Breathe After you stop, breathe deeply to release physical tension�most time one tends to hold breath in the midst being stressed�even a momentary interruption can help. Reflect Focus energy on problem & reflect on the cause of stress. Choose Time to choose how to deal with stress.

19. Relaxation Response (Benson) Use mind to change physiology Inborn set of physiological changes that offset flight or fight response The physiological responses are reductions in HR, BP, RR, & muscle tension Used to counteract harmful effects of stress. Practice diaphragmatic breathing (i.e., slowly & deeply) Pick a focus word, phrase, image, or prayer; or focus on breathing. Sit quietly in comfortable position. Close eyes & relax muscles Breathe slowly & naturally � as you do, repeat focus word or phase as you exhale. When other thoughts come to mind, just go back to repetition of word or breathing. Do this 5-10 minutes qd or bid

20. What Gets In The Way Of Taking A Moment Clearly not profound recommendations So what gets in the way: We are not good at monitoring our personal stress level We tend to take care of others & NOT ourselves. We are obsessive by nature. Our clinical & research work is isolating & overpowers personal needs. We are overworked and do not have the time to take the time even a few minutes a day. Other reasons???? The bottom line: Taking out one or two things does reduce stress�just a few minutes can make it better.

21. �A Safe Place To Talk�Even a few minutes can help to reduce your distress.OCS can be a first step.

23. References for Organizational/Stress Management Odette Pollar Organizing Your Work Space. A Guide to Personal Productivity Elain St. James (Hyerion Books) Simplify Your Work Life: ways to change the way you work so you have�more time to live ('01). Simplify Your Life: 100 ways to slow down and enjoy the things that matter ('94). Inner Simplicity: �100 ways to regain peace and nourish yoursoul ('95). Julie Morganstern (Henry Holt & Co.) Time Management from the Inside-Out ('02). Organizing from the Inside-Out ('98). �Richard Carlson (Hyperion Books) Don't Sweat the Small Stuff at Work: �simple ways to minimizestress and conflict ('98). Herbert Benson (Harper Torch) The Relaxation Response ('75). Karen Reivick & Andrew Shatte The Resilience Factor: 7 essential skills for overcoming life'sinevitable obstacles ('02).