Healthy approaches to physician stress.

Many studies demonstrate that physicians in training and in practice experience considerable distress, with a high incidence of dysfunction and dissatisfaction. Little is known about the strategies employed by practicing physicians who find enjoyment and satisfaction in their work. We conducted an open-ended survey about how a group of physicians cope with common dilemmas they face today such as mistakes, death, self-care, uncertainty, patient demands, and time demands. We describe the techniques employed by those who felt they were effectively coping. Responses were organized into five general requirements for personal growth: (1) self-awareness, (2) sharing of feelings and responsibilities, (3) self-care, (4) developing a personal philosophy, and (5) nontraditional coping skills of reframing and limit setting. General descriptions of these requirements are followed by tables of specific examples from the survey. The application of these strategies to the dilemmas cited above are presented. These descriptive findings emphasize the need for training programs and governing bodies to incorporate strategies for physicians' personal growth into their priorities. The five basic areas described herein can provide a framework for formal attention to physicians' personal development.