August 15, 2004

 

 Managing stress and avoiding burnout - August 15, 2004

 

Anyone who flies is familiar with the preflight safety briefing concerning use of the oxygen mask in case of loss of cabin pressure: affix your mask first, and then attend to others.

There's an important lesson there for people in a caregiving field: those who do not take care of themselves might reach a point where they cannot care well for others.

Just as an airline passenger who is adequately oxygenated will be of much greater service to fellow passengers, a veterinarian who takes care of himself or herself will be in a better condition to take care of patients, take care of business, and attend to family matters.

So what is it that leaves so many veterinarians "gasping for air" at work and at home?

Often, the source is external. The stress of organizational pressures and/or a difficult work environment can manifest itself in emotional or physical symptoms—anger, sadness, lack of concentration, inability to sleep. Chronic stress has even been blamed for weight gain, because stress produces cortisol, and elevated cortisol concentrations may promote deep abdomen fat storage.

The problem can also stem from within—from the very nature of being a caring person in a caring profession. Dr. Lisa Miller, former chair of the AVMA Committee on Wellness and a faculty member at Atlantic Veterinary College, University of Prince Edward Island, notes there's even a name for the problem of caring for others at the expense of oneself: "compassion fatigue."

Compassion fatigue results when an individual is depleted of internal emotional resources. People in caregiving professions, especially those who work in emergency situations, can be vulnerable.

"Because of the caring nature of our field, some of us practice our empathy to the extreme, to the detriment of ourselves," Dr. Miller says. "If we don't fill up our 'empathy bucket' from time to time, we run out."

Dr. Miller points out that, while many veterinarians have taken the time to learn how to help a client during a difficult time—the death of a pet, for example—those same veterinarians may not be as attuned to the toll these situations take on themselves.

The good news is that the awareness of stress and compassion fatigue has grown in recent years, and is being addressed more and more in veterinary school.

"It can be a difficult subject to address," Dr. Miller says, "because everyone comes to it at a different level. And because it's not a hard science, it may not be a priority for some veterinary students and veterinary educators."

"When you're newly graduated," she points out, "you're trying to learn all the hard skills—it's easy to put off learning the soft skills."

But it's a subject Dr. Miller feels must be addressed. "It's important to ask, 'Why do veterinarians leave the field? Why are some individuals not coming into it?'"

Dr. Miller counts down the many stresses one contends with as a student and then veterinarian, day in and day out. Veterinary school is exceptionally competitive. The early years of practice can be grueling, with a huge debt load to manage and the challenge of learning all the skills the profession demands. Through the years, health issues may crop up. Balancing work with personal and family priorities can be tricky. Signing employment contracts, considering a change of jobs, or planning for retirement are all scenarios that can be stressful.

For the many solo practitioners in small towns across the country, isolation can be an added frustration.

Having a strong support system—professional colleagues, friends, family members, and others in whom to confide—is one of the basic recommendations for reducing stress. Some others are as follows.

Take care of yourself. Most veterinarians already know how to do this but don't always make their own health a priority. But eating right, getting enough sleep, and making time to exercise will pay big dividends in providing the stamina to cope with daily stresses. Make health a priority.

Have fun on a regular basis. Novelist Iris Murdoch wrote: "One of the secrets of a happy life is continuous small treats." It may also be one of the secrets to a less stressful life. Big treats like a dream vacation may help relaxation (or may actually add to stress with the planning, the expense, and the worry of missing work). But little treats, done on a regular basis, can be an effective way to cope with daily stress. Take your kids to the park. Try a new restaurant. Join a ________ (fill in the blank with something you love) club/team. Have a hot fudge sundae. Spend time with friends who make you laugh. Go see a game. Go play a game.

Turn to nature. The great outdoors can be a great stress reducer. Take a long walk through a local park. Plant some flowers in the back yard. Plan a weekend getaway to the mountains, the woods, or the beach. Lie on your back and study the clouds.

Find a relaxation technique that works for you. This may take a little experimentation, but give it a try. Explore deep-breathing exercises. Consider yoga. Try meditation. Focus on your spiritual side. Knit or paint or play the piano. There are many published, online, and community resources for learning about the wide variety of relaxation techniques.

If you can't change the stressors, change your attitude. Expect the best. Think positive and spread optimism when you can—it will come back to you. Allow yourself to not be perfect. Try to look at conflict as an opportunity to grow. Prioritize what's truly important in your life. If you can appreciate that your marriage is happy, or your parents are healthy, or your kids are thriving, then you can more easily write off a bad day at work.

Know when to ask for help. Everyone experiences occasional frustration or weariness. But when the bad days outnumber the good ones, it's time to consider seeking professional help. Dr. Miller has categorized some cognitive, emotional, physical, and behavioral symptoms of stress that serve as warning signs: the inability to concentrate; feeling confused or forgetful, or thinking of several things all at once; being quick to anger; feeling anxious, depressed, guilty, or frustrated; experiencing chest pain, fatigue, sweating, trembling, or frequent headaches, colds, nausea, or other unexplained aches and pains; drinking excessively; throwing or breaking things; yelling; or crying.

One of the biggest favors any veterinarian can do for his or her patients, colleagues, and family is to take self-care and stress control seriously. For those desiring an introduction (or a refresher course), Dr. Miller highly recommends "Stress Management for Busy People," by Carol Turkington.

Dr. Miller offers other practical suggestions. If stress levels are rising at work, organize staff meetings to discuss concerns and feelings. Reassess the boundaries that have been developed with clients. Give yourself permission to grieve when you lose a patient. Surround yourself with supportive people. If you decide to seek help, try to identify a counselor or psychologist who understands compassion fatigue and is familiar with the veterinary profession.

For every veterinarian who is committed to truly being there for clients, colleagues, family, and friends, here's one final thought from the Roman poet Ovid. His counsel: "Take rest; a field that has rested gives a bountiful crop."

Two millennia later, the advice still holds true.

Prepared by the AVMA Group Health and Life Insurance Trust