Chapter 14. Looking after yourself
Occupational health department and personal health 418
Aggression and violence 420
Difficult colleagues and colleagues in difficulty 422
Complaints handling 424
OCCUPATIONAL HEALTH DEPARTMENT AND PERSONAL HEALTH
The contact that doctors have with patients on a daily basis increases the risk of both contracting and spreading infection. Therefore, it is a personal and professional responsibility to wash your hands, use alcohol disinfectant hand gel (see ‘HAI’, p. 441) and wear appropriate protection when performing practical procedures, as described in the relevant chapter.
An awareness of your own health is also essential. You should be able to recognize when your capacity to work is limited by physical, mental or emotional difficulties and be prepared to take appropriate action.
Occupational health
Occupational Health (OH) departments help to ensure that NHS staff are physically and mentally able to undertake the work required of them. However, they are not a substitute for a GP and you should ensure you are registered with a local practice. The main contacts you can expect to have with OH are:
• when you are required to demonstrate that your immunity to hepatitis B infection is satisfactory: every time you move into a new health board
• for assessment and advice in the event of illness or injury that has occurred as a direct consequence of your employment, e.g. infectious diarrhoea, needle-stick injury
• for assessment and advice regarding a prolonged illness or a condition that may be adversely affected by work, e.g. back or joint injury; stress or depression
• for vaccination against organisms other than hepatitis B, e.g. influenza.
Hepatitis B status
You need to be immunized against hepatitis B infection and have a booster every 5 years. You will need to provide proof of such immunity before you can work. Therefore, you should keep and present a copy of your vaccination certificate when required.
Exposure to blood-borne viruses
Where you are exposed to blood or blood-contaminated body fluids, take the following immediate action:
• mucocutaneous exposure: where skin, nose, eyes or mouth are affected, rinse with copious amounts of water (or a saline drip into eyes and nose)
• needle-stick injury: squeeze around the wound to induce bleeding, but avoid pressing on it directly; then wash with soap, but without scrubbing.
Further action
This will be dictated by the risk posed by the patient. Therefore, they should be questioned (not by you) regarding risk factors for blood-borne virus (BBV) infection, e.g. intravenous drug use, body piercing and tattoos (especially if performed overseas), high-risk sexual contact and previous transfusions. The incident should be documented in the patient’s case-notes in addition to their consent, if given, for BBV testing. A clinical incident report form should be completed. Thereafter, you should contact OH (or A&E out of hours), who will coordinate the following as appropriate:
• sampling of your own blood for viral testing
• antiretrovirals, a hepatitis booster or hepatitis immunoglobulin depending on the perceived risk based on the patient’s history
• a review a few days later with the results of the patient’s blood tests to determine if a high risk exposure has taken place; if so, you may be advised to give further blood for testing in a few months, not to donate blood, to practise safe sex and to avoid undertaking surgical procedures.
A stressful job
Stress is a normal part of our everyday lives. Our physiological responses are inbuilt and have evolved to help us survive situations involving actual or potential physical danger. However, the same physiological response may be triggered by psychological stress.
In small amounts, stress can be helpful, making us more efficient or helping us rise to a challenge, e.g. dealing with a cardiac arrest. However, more persistent stress levels are rarely helpful and usually occur when we feel unable to cope with what is required of us. This perception varies from individual to individual and from day to day. It is influenced by external and personal factors and the coping strategies we have learned. The individuality of stress means it can happen in any branch of medicine. Furthermore, a change of career path may not reduce your stress levels if you have not learned how to recognize stress and modify it.
A situation at work is more likely to cause stress when it happens in the context of other personal problems, fatigue or hunger. In addition, a desire to please everyone and a need for perfection can magnify problems out of all perspective. Stress is cumulative: a small stress on top of others can be all it takes for your performance at work to be affected, for you to feel overwhelmed or become ill.
Recognizing the signs of stress
Stress affects different people in different ways:
Physical
• cardiorespiratory: increased heart rate, fast and shallow breathing
• gastrointestinal: nausea and vomiting, heartburn, diarrhoea, changes in appetite
• general: headaches, back pain, blurred vision, cold or sweaty hands and feet, dry mouth, increased number of minor illnesses, change in libido or sleeping patterns, fatigue.
Psychological and behavioural
• increased errors or clumsiness, e.g. ordering a test for the wrong patient, a ‘near-miss’ in the car
• increased emotional lability, irritability, irrational thinking, loss of perspective
• increased compulsive behaviour, e.g. cleaning, smoking
• negative thoughts or defensiveness.
Coping during times of stress
• recognize that you are stressed
• recognize that you have a choice: control it or allow it to control you
• fix a time in your mind when you will pay special attention to yourself and any stresses; then focus on the current tasks, one at a time
• take extra care to be polite, considerate and pleasant
• take special care when undertaking complicated tasks, e.g. ask for assistance with a procedure; drive slowly
• accept help and delegate where appropriate
• if possible, take a few minutes alone to pause, breathe and reflect on what has gone well recently, or on something that you particularly enjoy
• get as much sleep as you can and try to fit in some exercise, even walking
• do not skip breakfast
• eat regularly but avoid heavy meals
• avoid large amounts of coffee, alcohol or chocolate.
Stress debrief
When we are stressed is it easy to forget what it is like to be ‘normal’. You can address this with simple measures, e.g. observe and take pleasure in ‘small’ things (less traffic on the road to work, a lovely view, thanks from a patient); keep in touch with your friends; sleep lots and exercise. Specific stress reduction techniques fill many books, the following are only a few suggestions:
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