“This Job Is Killing Me”
“And how have things been at work recently?” – The standard question in any medical interview. Over the past few months it has developed a much sharper edge. As the threat and reality of redundancy bites and with applicants in one West London Jobcentre up by 22%, avoiding and treating work related stress has become even more relevant.
A man came to see me last week, same age as me, which for some reason always sharpens the concentration. Pressure at work building up over the past year, increased hours, demands, deadlines, management consultants saying “We’ve got a zero trust policy”,reduced resources, restructuring, rationalisation, a full set of euphemisms which meant more for him to do and less time and help
with which to do it. “On my way to the tube on Monday morning I just broke down in tears. I couldn’t get on the train. I’ve never been like this before. What is happening to me…?”
The health and safety executive tell us that work related stress is defined as “the adverse reaction people have to excessive pressure of work or other types of demands placed on them”.
The adverse reaction can show up in one of several organs. My first house-job was in cardiology at Charing Cross where the consultant based there was a pioneer in holistic medicine, before the term was invented. He saw a huge number of patients with arrhythmias, cardiac failure and other problems; much of these had been contributed to by pressure of work.
He avoided cardiac drugs and his multidisciplinary team used initial sleep and rest graded exercise and breathing techniques and a change of life and work circumstances to restore the heart and body to fitness. The knock on positive effect on the mental state was remarkable. The adverse effect on the GI, pulmonary and endocrine systems of those ‘drowning in adrenaline’ is familiar to all of us. Last week I saw a GP – surely the hardest working, uncomplaining, stoic to the last workers in Britain?! She was on a stable dose of thyroxine but had ended up in CCU with a fast AF. To her endocrinologist it was obvious that this was largely due to working 10 full sessions a week and taking on management responsibility for an 18 partner practice, as well as supporting three children and a husband.
And so to Woody Allen’s second favourite organ, the brain. The slow insidious build up of work related stress over months and years will eventually, sometimes with a small trigger, show itself as a debilitating combination of anxiety and depression. Most fail to recognise the slow build up to burn-out and increasingly their inability to cope with day-to-day responsibilities. “I should be able to deal with this… I’m a coper… I’m so tired all the time… I’m weak”.
Often marital health will be the first sign: “He’s so grumpy, so irritable, really Victor Meldrewish…” Squabbling, Friday night rows, taking it out on or ignoring the children. And turning to the Sauvignon Blanc to solve the problem. Alcohol sales remain buoyant in the recession. There is a lot of selfmedicating going on. I’ve come to the conclusion in my addiction practice that half the traffic at night on London’s streets is delivering cocaine or cannabis. NOT helpful.
So what is the solution? Much of it lies with the cause:
- Long Hours
- Excessive workload
- Changes in organisation
- Tight / unrealistic deadlines
- Changes in duties
- Job insecurity
- Lack of autonomy
- Insufficient skills
- Excessive or insufficient supervision
- Poor working environment
- Lack of equipment & resources
- No promotion
- Harassment / bullying
- Poor relationship with boss / colleagues
If employees can recognise these stressors and begin to negotiate changing them it can be very empowering. This requires a degree of assertiveness and encouragement often from spouses, work colleagues or even their Union or professional body.
If it is already too late and anxiety and depression have taken over then clearly they need time off with as much psychological support as is available. So many are much more depressed than they realise, often revealed by questionnaires (BDI-PC / BDI II).
I often say to patients that I’m not a pill salesman but SSRI’s can be really useful. After time off and recovery it is vital that patients do not return to exactly the same situation – they will just get unwell again.
This may often require a clear statement of this from their GP or Psychiatrist to HR or Management. It is in the employers’ interest to keep their employee well. “If you don’t buck up your ideas mate your job is going to Moscow” A patient was recently told this by a line manager at the Big Bank. However with some negotiation and some assistance from me, his therapist and firm communication to HR, he was able to change his work schedule. There’s still an empty chair in Москва!