19 Aug You, Your Stress Level and Your Health
I had a doctor who used to tell me that a certain amount of stress was good for me. And I have to agree. I like the adrenalin rush of working on a deadline, of juggling priorities to meet objectives and the exhilaration of making it all work. Stress keeps us on our toes. In small doses, stress may be a good thing. But there’s no question that a high stress level affects your health.
In The New York Times, Dr. Dhruv Khullar tells a compelling story about stress and its physical manifestations during his residency.He was in his mid-20s when he found his first gray hair; and for the first time he noticed his body aging–not getting better, but starting its decline. A new study shows how long hours, disrupted sleep and constant stress can take a biological toll on newly minted doctors.
University of Michigan researchers tested the DNA of 250 first-year medical residents around the country. They took samples of their saliva to examine the length of their telomeres–the protective caps at the ends of chromosomes that prevent DNA damage. They took samples before and after the first year of residency.
Telomeres: Linked to age-related diseases
Telomeres shorten every time our cells replicate; they act like a fuse at the end of DNA. Once they become too short, cells know that it’s time to retire or self-destruct. Telomere attrition plays a role in the aging process and it’s linked to age-related diseases, including diabetes, cancer and heart disease.
DNA of first-year residents aged six times faster than normal
Telomeres normally shrink at a rate of about 25 DNA base-pairs per year. However, first-year medical residents experienced an average decline of more than 140 base-pairs! Residents who worked longer shifts or more hours were at even higher risk. Telomere shrinkage increased steadily with the number of hours worked, but skyrocketed for those working more than 75 hours per week to more than 700 base-pairs. Compare that to the normal rate of 140.
“Most prior research on residency wellbeing has used self-reported questionnaires,” said Dr. Srijan Sen, the study’s senior author and an associate professor of psychiatry at the University of Michigan. “We hope that showing measurable physiological effects at the cellular level will help catalyze residency reforms that really move the needle.”
How long and how hard should trainees work?
This is a perennial debate in medicine. But it has new urgency amid growing recognition of widespread anxiety, depression and burnout among medical trainees and physicians.
This study comes on the heels of other research showing that doctors in training lose three to seven hours of sleep per week and are much less physically active compared to their pre-residency lives. A vicious cycle emerges: Short sleep leads to worse mood the next day, which in turn makes it harder to sleep at night, culminating in a chronic depressive state.
There are opportunities to improve wellbeing in medical training
- Structured wellness programs are emerging. At Stanford’s Balance in Life program,started in 2011 after the suicide of a surgical residency graduate, trainees receive a comprehensive set of resources to support professional and personal wellbeing.
- A mentorship program allows junior residents to meet regularly with senior trainees and faculty members to discuss their concerns and goals.
- Every six weeks, residents meet with a clinical psychologist to share challenging experiences and discuss personal issues.
- While on call, they have access to a dedicated refrigerator stocked with healthful snacks and beverages.
- All residents are encouraged to have regular checkups with their own doctors and dentists, an elusive luxury during medical training.
Medical training is intense and that’s not likely to change
Developing the skills and intuition required of doctors requires a certain immersion. But the current system strains trainees along their journey. Turning this into a grueling marathon can be detrimental to both doctors and patients.
Many Americans are stressed out and sleep-deprived
Of course, it’s not just in medical school and residency programs that we find those who are sleep-deprived and stressed out. Compared to other developed countries, Americans work longer hours, have poorer childcare options and shorter vacations. Here in the Bay Area, we love our quality of life, but we have to work all the time to be able to afford it. Doctors don’t have a monopoly on stress. Stress is single moms working two jobs to support their families, etc. This study confirms what they already know: Excessive levels of stress keep them awake at night; they’re unhealthy and make them age faster.
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