Dealing with stress among healthcare professionals: are we missing the elephant in the room?

This article was exclusively written for the Sting by Mr Lukas Neimanas, a 5th year medical student, a member of the junior doctors bureau. Lukas is affiliated to the International Federation of Medical Students Associations (IFMSA). However, the opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one. In order to provide humane and efficient care, contemporary healthcare (HC) professionals are required to demonstrate maximum level of empathy and clinical expertise. Naturally, these values are incorporated in undergraduate and postgraduate medical training programs. But the current reality indicates that we are sending healthcare workers into environments full of death & disease, hectic work pace, sleep deprivation, without equipping them with necessary tools to handle such situations [1]. There’s no surprise burnout rates are reaching their peaks among medical professionals in the developed countries [2]. Current focus is on dealing with the results of chronic stress and burnout, but we are missing the root cause. It’s not uncommon for medical students or residents to take an occasional benzodiazepine amidst the exam rush; coffee and cigarettes are the norm of a night shift. But is this the right way to cope with the growing expectations of the medical community? Witnessing the results of burnout and job satisfaction scores among HC personnel should prompt us to find ways to improve the performance of people taking care of our lives – just like the military [3]. Multiple monitoring modalities detect symptoms of diseases early on, millions are spent on lab tests and machines, but what do we know about the person making life & death decisions on a busy night shift? Is their performance optimal? Fortunately, we have methods such as heart rate variability (HRV) measure. This simple, non-invasive technique can tell the real-time balance of person’s autonomic nervous system, which in turn affects stress resilience, cognitive functioning, emotional response and more [4]. We monitored the pre-shift HRV data of our site’s emergency medicine (EM) residents on 6 random days during the month. Additionally, the participants were assigned to different guided morning meditations, which we hoped would increase their performance. The first finding was astonishing – these young and, seemingly, healthy people demonstrated complete lack of HRV balance, with lowest values reaching those of people with acute myocardial infarction [figure]. If such values were witnessed in professional athletes, they would be suspended from training. But here, we have people coming in and working under intense stress conditions without minding what is happening with them. The second finding was also unexpected – our idea of increasing residents HRV (together with stress resilience and cognitive functioning) with guided meditations failed. We’re not saying meditations don’t work, it’s just that they are probably not the best tool to start for people who choose stressful medical specialties. What is suitable then to improve the performance of people who take care of our lives and wellbeing? That remains to be answered. But in order to get to these answers, first we have to face the reality – training of healthcare professionals to meet the current standards of best practice is insufficient. Just providing theoretical and technical skills is not enough if we want to have vibrant, energetic and competent HC professionals. Looking in is the only way out. References

1. Bazarko D, Cate RA, Azocar F, Kreitzer MJ. The Impact of an Innovative Mindfulness-Based Stress Reduction Program on the Health and Well-Being of Nurses Employed in a Corporate Setting. J Workplace Behav Health 2013 Apr;28(2):107-133.
2. Barbosa P, Raymond G, Zlotnick C, Wilk J, Toomey R,3rd, Mitchell J,3rd. Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Educ Health (Abingdon) 2013 Jan-Apr;26(1):9-14.
3. Russell A, Deuster PA. Human Performance Optimization and Precision Performance: The Future of Special Operations Human Performance Efforts. J Spec Oper Med. Spring 2017;17(1):80-89.
4. Lu WC, Tzeng NS, Kao YC, Yeh CB, Kuo TB, Chang CC, et al. Correlation between health-related quality of life in the physical domain and heart rate variability in asymptomatic adults. Health Qual Life Outcomes 2016 Oct 21;14(1):149.

Figure. The “emotional roller-coaster” of emergency medicine residents’ HRV data. About the author I am 5th year medical student, a member of the junior doctors bureau. I work with boosting the well being of health professionals. My main goal is to create a workplace where doctors, nurses and staff are prepared to face acute stress and not become burned out.  I am also an active teaching instructor and teaching coordinator in the project “Auksinės minutės” where our main goal is to teach children the basics of first aid and encourage them to be active participants in social life so they could provide life saving measures. My future goals include effective management of hospitals and university teaching programs.