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Doctors and anxiety

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jonathon tomlinson

on 3 November 2016

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Transcript of Doctors and anxiety

Generalised (GAD)
social Phobia
Specific phobias
OCD
PTSD
Panic disorder
Where does anxiety come from?
GENES
pAST EXPERIENCES
PRESENT CIRCUMSTANCES
tYPES OF ANXIETY
Anxiety and medical practice
empathy
transference
Uncertainty
complexity
intensity
isolation
exhaustion
denial
rationalisation
projection
splitting
displacement
sublimation
etc.
primitive defenses
against anxiety
regulation
inspection
complaints
media hostility
re-disorganisations
contracts
social defences
against anxiety
loss of continuity
subspecialisation
protocols/ pathways
redistribution of responsibility
depersonalistion
etc.
the containment of anxiety is part of the psychological contract between an organisation and its staff
risks of anxiety
depersonalisation
excessive self-criticism
unnecessary self-sacrifice
Hypervigilance
over-medicalisation
depression

self-awareness
emotional intelligence
vigilance
empathy
compassion

benefits of anxiety
Objectives:

1. Learn about what anxiety is and how it manifests

2. Think about what makes doctors anxious

3. Learn about defences against anxiety

4. Think about how to live better with anxiety
Anxiety and Doctors
“If man were a beast or an angel, he would not be able to be in anxiety. Since he is both beast and angel, he can be in anxiety, and the greater the anxiety the greater the man. He who has learned rightly to be in anxiety has learned the most important thing.”
Søren Kierkegaard 1844
How does anxiety manifest?
"If we feel that our minds are ‘breaking’, we panic and that acute anxiety pulls us away from our rational problem solving ability so that we become aggressive to those who show concern, or we withdraw, or just freeze feeling powerless and helpless.

Add in a large dollop of stigma-induced shame and suddenly the actual difficulty is infused with additional layers of mental slurry and we feel our sanity is leaving us; we fear that we are going under."
Tanya Byron: The Skeleton Cupboard
"Thoughtful clinicians are aware that diagnostic categories are simply concepts, justified only by whether they provide a useful framework for organising and explaining the complexity of clinical experience in order to provide predictions about outcome and to guide decisions about treatment."
Jablensky and Kendell: Criteria for Assessing a Classification in Psychiatry, 2004
Jonathon Tomlinson
abetternhs.net
@mellojonny
“If fear is fearful of something particular and determinate, then anxiety is anxious about
nothing in particular and is indeterminate. If fear is directed towards some distinct thing in
the world, spiders or whatever, then anxiety is anxious about being-in-the-world as such.
Anxiety is experienced in the face of something completely indefinite. It is, Heidegger insists, ‘nothing and nowhere’”
Critchley, 2009
What is anxiety?
“Something has gone wrong with the clinical relationship (or for that matter any client-professional relationship) when clinicians quote figures, survival rates, and probabilities of side effects at their patients instead of offering them educated professional guidance and support in the difficult process of reaching a decision.”
West, 2002
“Few people outside medicine know that what troubles doctors most is uncertainty”
“We are experiencing a massive, ravenous investment in tools of scrutiny and inspection and control, massive investment in contingency, and massive under-investment in change and learning and innovation.”

“Inspection does not achieve continual, pervasive, never- ending improvement. It doesn’t foster creativity or learning or pride, it poisons them, because the main harvest of inspection isn’t learning, its fear.”

Don Berwick Era 3 for medicine and healthcare, 2016
The kinds of people we care for
The kind of work we do
The kinds of people we are
The kinds of people we work with
The kinds of organisations we work for
What makes doctors anxious?
Containing anxiety
Personal
Interpersonal
Organisational
Material

id
ego
superego
Full transcript