Advanced coping skills for pediatricians during high stress

At the virtual 2021 American Academy of Pediatrics National Conference & Exhibition, Hilary McClafferty, MD, FAAP, Section Chief, Medical Director Pediatric Emergency Medicine Tucson Medical Center in Tucson, Arizona started off her discussion by noting, “Working in pediatrics involves high responsibility, high stress, and high stakes to begin with. There is also a variable sense of control, when health care workers are at the mercy of productivity mandates and other metrics.” She also pointed out that the COVID-19 pandemic, with no immediate end in sight, adds to that feeling of variable control.

While the opposite of well-being is “emotional exhaustion, depersonalization, and a loss of a feeling of personal accomplishment,” well-being, she asserted, is more than a matter of coping, but a sense of thriving, “setting yourself up for success in a proactive and positive way.” Common traits of resilient people who feel a regular sense of well-being include strong social connections, emotional awareness, the ability to ask for help, being able to take care of themselves, and a sense of optimism.

So where does one start in learning how to thrive at work and lower their stress response? McClafferty discussed her SENS model of physician wellness and resilience, which takes into account 4 foundational areas: sleep, nutrition, exercise, and stress management, the latter of which she focused on for this presentation. Start, she said with these 4 questions: what is in your control, what are your available resources, what do you need that you don’t have, and what can you let go of, with this last question, McClafferty said, “incredibly important.”

Next, McClafferty said it is important to note both physical and behavioral signs and symptoms that change when you are under undue stress. Becoming skilled at recognizing your early signs of the stress response will make your more effective at reducing stress back to a healthy level. The opposite of the flight or fight response, said McClafferty, is to identify, isolate and trigger the physiologic relaxation response. These can range from breath control exercises to autogenics (where someone repeats a set of statements and visualizations to induce a state of relaxation), mindfulness, guided imagery, progressive muscle relaxation, and other tools.

In summary, McClafferty said, recognizing the concept of both healthy resilience and your own stress response; isolating and triggering your relaxation response; and going through a brief exercise (muscle relaxation, mindfulness, etc.) will bring your stress response back to healthy levels. Finally, McClafferty urged practitioners to identify 1 short-term goal (“what can I start today?”) and 1 longer goal (“I commit to this change over the next 12 weeks”).