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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 9; 334(7605): 1224.
PMCID: PMC1889958
From the Frontline

Wanted: stress monkeys

Des Spence, general practitioner, Glasgow

I ran, under pursuit. His hot breath was on my neck, but my two extra years kept me those important few metres ahead of my bloody and swearing younger brother. It was an accident. And of course a pitchfork through the hand is going to hurt a bit, but this was nothing to the time he was knocked unconscious by a falling concrete block: his head wound eventually stopped bleeding and Mum let him sleep it off. Farm work was dangerous. People got gored by cows, kicked by horses, crushed under bales, and sucked down into slurry pits. The hours were terrible, the pay rotten, and the smell of the uniforms—boilersuits and wellies—indescribable. We were city kids turned feral and we loved it. Thirty years have passed; we laugh about the scars and our children yawn and roll their eyes at “the stories.” But our modern children have been reduced to a perpetual state of fear in our current health and safety police state.

The health and safety wardens sound the “stress” sirens. A recent survey found that 70% of nurses experience work related stress and that 30% of sickness absence in the NHS is due to stress. Occupational health departments, their case load once full of asbestos exposure, burns, and trauma, are now having to deal with an explosion in the incidence of stress related illness. An occupational health principle, “the hierarchy of control,” seeks to limit risk from the top down—stopping children working on farms, for example. But how can we operate this principle with regard to stress?

Being a nurse or a doctor is stressful. It says so in the job description. Sleepless nights, early waking, worry, guilt, anger, frustration, and anxiety induced chest pains are all part of the package. That survey found that nurses are responding to stress in the time honoured way: by smoking and drinking. I suspect that dark humour and swearing are still widely used stress busters too.

However, I don't think that the stresses stem from poor pay, lack of respect, uncertainty, or long hours, as suggested in the survey analysis, for these have much improved in the past decade. The reality is that working with patients and their families is inherently stressful. All that counselling, Indian massage, playing with stress balls, whale music, pan pipes, and those excruciating dull and expensive courses will make no difference. Society is more demanding now, unrealistic, selfish, less respectful, and we in turn are left trying to deliver the undeliverable.

Therefore university prospectuses should be more honest. Rather than seeing images of relaxed and smiling doctors in white coats gathered around a microscope we should see hungover, frazzled doctors and nurses huddled at a fire exit smoking together. The caption might read, “A career that pushes you to the edge and then flings you over it.” I wonder whether in 30 years I will look back and laugh at all my work based psychological scars.

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