Additional Stressors

Stresses in the practice of medicine and in one's personal life are inevitable. Sources of stress come from the job—dealing with suffering and death; uncertainty; self-perceptions of inadequacy; recurring academic deadlines, including recertification; and recent changes in the health care system, including loss of autonomy stemming from managed care—and also from outside pressures, including family and finances. Some physicians

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In a study conducted in Great Britain, the most significant source of stress for those beyond their training years was lack of control of circumstances at work.^[134] Specific causes included professional relationships (especially with surgeons), work overload, threats of litigation, peer review, and increasing administrative responsibilities. Added to these causes were conflicts between professional pressures and personal life. It is not surprising, then, that a subsequent survey of retired members of the ASA identified similar stressors. In this study, difficult anesthetic cases, the threat of professional liability, and the stress of night call were all considered to be significant causes of stress. ^[135]

Perhaps more than any other medical specialty, the practice of anesthesia requires uninterrupted vigilance with immediate reaction to life-threatening situations. An inappropriate response can prove to be acutely fatal to an otherwise healthy patient. It is reasonable, then, to ask whether the day-to-day practice of anesthesia produces episodes of significant physiologic stress in the practitioner. Studies to date do not support this hypothesis. In an investigation of 38 anesthesiologists over the course of 203 anesthetics, clinically significant changes in physiologic stress as measured by changes in heart rate, blood pressure, and cortisol levels could not be documented.^[136]

In recent years, professional dissatisfaction with medicine has been identified as an additional source of stress among physicians. It has been attributed by some to increasing health problems in the expanding elderly population, to the rapidly rising cost of health care, and to advancing technology.^[137] Managed care, an evolving force in the practice of medicine in the United States, has become a source of stress that has motivated a significant number of physicians to leave medicine.^[138]

Management of stress is rarely addressed in medical school or in continuing medical education seminars for anesthesiologists, but it should be. Rather than being a sign of weakness, stress is a universal phenomenon to which no one is immune. Vital to our interactions with others is the ability to recognize stressed behavior, not only in them but also in ourselves. Healthy means of coping with stress include an ability to communicate, appropriate assertiveness, interactive management of conflicts, adequate time with family, and time for recreational pastimes totally unrelated to professional activities.