The joy of stress

Authors: Cath Janes 

Publication date:  16 Apr 2009

Medicine is always thought of as one of the most stressful careers you can have. Cath Janes says doctors should embrace that

If you’re having one of those days when you’d happily chuck in your medical career for a vocation that’s altogether less stressful, look away now. The following statement may send you over the edge.

“Pressure is good. It keeps me motivated,” explains Dr Una Coales, a London based GP and MRCGP course organiser. “I did my medical and surgical training in the US and when I came to the UK I sat a UK licensing exam. I studied for the length of my first pregnancy, receiving my pass result on the day that I gave birth. I went on to pass the FRCS exam as well as the FRCS (ENT) during which time I had another two children. I then passed my MRCGP exam before writing a book on it. I’ve now written 11 exam books in all.

“I’d lose interest if I was in a mundane nine-to-five job. I tried working in private occupational health after completing my GP training but there was no mental challenge. I felt like a mindless robot. What I do now is pressurised but I enjoy it. In fact, passing the FRCS exam as an international medical school graduate and mother of three is my greatest achievement.”

Not the words you expect from an overworked and bleary eyed doctor, are they? They are, though, the words of someone taking a refreshing approach to the whole notion of stress within the medical profession.

Stress fracture

You’ve heard the statistics. Almost weekly there’s a wellbeing survey, study, or piece of research warning the nation’s workforce that stress is coming to get them. It’s the cloud on every medic’s horizon. According to the Health and Safety Executive in the UK work related stress lies at the root of over a third of all new incidences of ill health, while 13.5 million working days were lost during 2007-8 thanks to work related stress, depression, and anxiety.

The question is whether this national obsession with workplace stress is doing as much damage as it professes to prevent. If we tell ourselves that we are stressed at work won’t we become just that? The blanket assumption that all doctors are stressed and that this stress has to be eradicated is a premise that, taken to the extreme, could have the entire medical profession taking to its bed. Rather than realising that nerves can make us shine at surgical procedures or understanding that we feel pressure because we want to succeed, we’ll define anything that raises our heartbeats as dangerous and avoid it.

“To live without stress would be to live in a vegetative state,” warns Glynis Kelly, senior lecturer in psychology and sociology at Cornwall College, the UK’s largest further education provider. “It’s just not viable. Even the act of getting up in the morning requires effort. And for many it is the fact that they feel ‘driven’ that makes the job worthwhile and that once that feeling is gone it is time for them to move on. It is this environment that allows them to produce their best work.”

That doesn’t mean that emotional responses to trauma situations or bureaucratic overload are not valid. There is no question that the medical profession pushes people to their limits and that some doctors become racked with anxiety and are unable to fully function as a result. It simply means that too many of us have developed the habit of labelling normal reactions to stressful situations as abnormal. Are we becoming a nation of softies and is it time to revaluate our perceptions of stress?

A new kind of normal

Dr James Harrison is an ST3 in accident and emergency at Homerton Hospital in London. Here’s his take on the issue:

“At A&E the stressful things that could happen to you become normal. When you are under pressure every day you get used to it, it becomes a different type of normal.

“Yes, it is a pressurised environment but if you have the right mindset it is enjoyable. It’s about seeing situations as a challenge, searching your own knowledge and looking inside yourself to overcome the problems you face. I find that if I want to perform well I need to have the stick rather than the carrot and that’s why I’ve been attracted to this particular role.”

The problem occurs where one doctor’s idea of healthy pressure is another’s idea of breakdown inducing chaos. After all, is it really possible to compare the pressures of brain surgery to the pressures of being a GP? The general consensus is that it’s not, with each one of us displaying different tolerances and expectations. Being locked in a room with a snotty nosed toddler could send a brain surgeon around the bend while a GP facing her first craniotomy could feel nothing but exhilaration. It means that no one specialty is more or less pressurised than another.

“Our reactions to stress are very much personal,” explains Dr Wolfgang Seidl, executive director of The Validium Group, who specialises in management consultancy, psychotherapy and stress management. “Some people stay evergreen in the face of adversity while others shed their leaves and go into hibernation. It’s the resilient who view pressure as a challenge, not a threat. They trust that they have enough control over the situation and don’t perceive themselves as powerless. This strengthens individuals and the good news is that these attitudes can, to a degree, be learned.”

In support, Dr Seidl cites a major study that was based upon a meta-analysis of 293 independent studies reported in peer reviewed scientific journals between 1960 and 2001, with a total of 18 941 participants.[1] He says, “This compelling piece of evidence showed that short term stress actually strengthens our immune system. You could say that it is ‘good stress’ in that it is a stimulating factor that helps us to achieve goals and be successful. Any event that triggers fight or flight response would potentially lead to injuries healing faster if the immune system gets a boost and similar principles apply when sitting an exam.”

Fine balance

So is it possible to discern between “good” and “bad” stress? Dr Harrison believes so. “I find that there are two types of pressure. The pressure of working in the system, where you have to face four hours targets and waiting patients, and the clinical pressure of dealing with trauma patients. I respond to each differently. For me clinical pressure is easier to overcome than the pressure of being in the system and to an extent that is about how much control I have over what I am able to achieve.”

Which means it’s time to shake off the “stress victim” mentality and focus on the factors that we can influence. The result is feeling motivated, productive, and less like throwing a wobbly when faced with situations that are beyond our control. Essentially, it’s creating a balance.

“This increases our productivity and gives us a sense of achievement,” explains Glyn Morris, RMN and managing director of The Promised Land Partnership, which offers therapy to those suffering from stress, anxiety and depression. “It creates positive signals that we are in control and that helps motivate us further.

“It’s also about recognising that stress and excitement create the same feelings and that those feelings are only classed as ‘bad’ because we focus on our previous negative experiences. Take going on holiday and going to an interview. Both situations create the same biological responses but we’d describe the holiday as exciting and the interview as nerve-wracking. Why?”

Which is another argument for listening to our bodies rather than the endless scare stories about stress. What if we saw vivas as opportunities or trauma cases as a chance to show off years of training? Perhaps medical professionals should start thinking like athletes. After all, can you imagine 100 meter Olympic gold medallist Usain Bolt labelling his pre-race nerves as stress? He wouldn’t so much thunder down the home straight as dawdle along while begging his doctor for a sick note.

Brave new world?

Which is why it’s time to ignore the stress-peddling doom-mongers and start thinking about what a career in medicine means. It’s about rising to challenges that most people never face, changing lives, and striving for scientific excellence—worthy endeavours that are rarely pressure free.

Nikhil Kaushik, a consultant ophthalmic surgeon at North East Wales NHS Trust, has the last word.

“I love my work because of the challenges and excitement of fine surgery and a thrill of working with patients that requires a high level of concentration. It’s like a live stage performance with no chance of a second take.

“But what if that pressure was removed from the job? We’d end up taking on surgical specialties without engagement or involvement and that’s something that scares me. I cannot disassociate myself from giving my work my best shot.

“And wouldn’t monotony make our roles boring and dull? Humanity has come this far only because of the pressures and risks it has taken. I just hope that the practice of medicine at least is not reduced to routines.”

Competing interests: None declared.


  1. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull  2004;130:601-30

Cath Janes freelance journalist, Pontypridd

Cite this as BMJ Careers ; doi: