Managing Stress

In our modern era, “I am so stressed out,”is something you hear routinely from all types of people but especially patients. Yet, we rarely hear about doctors suffering from unhealthy and even pathological levels of stress and anxiety. It has gotten so bad that in certain sub specialties, such as anesthesia and surgery, suicides are approaching epidemic levels.

Yet, stress in and of itself is not necessarily a bad thing; in fact, when properly harnessed, stress can help to focus the mind and drive you to higher levels of achievement. Of course, in our modern world, the fight-or-flight mechanism gets triggered for any number of things despite their banality, and it is the constant “false alarms” that, in a chronic fashion, can lead to pathological levels of anxiety and action impotence/ procrastination, or even depression and other negative emotions.

I don’t pretend to be an expert on stress but through my own experiences, as well as the advice I have gathered through others (whether informally or through books) I believe that there several reliable things we can all do in order to minimize bad stresses and harness the good ones that can take us to the next level of success. Experiment with the suggestions below to see what works for you. Better stress management will not only lead to a better sense of well-being but also better outcomes for your patients (or clients, etc)

Acknowledge the anxiety

The first thing I do is to acknowledge the fact that I am experiencing stress! There is no shame in admitting you are anxious or fearful. When I was younger I wrongfully believed that the best performers, the biggest tough guys in the ring, the most successful people rarely if ever experienced anxiety or fear. This is SO NOT TRUE! A cursory list of some of the most famous people of all time who battled with various forms of anxiety will include, Gandhi, Thomas Jefferson, Sir Laurence Olivier, Barbra Streisand, Carly Simon, Adele, Hugh Grant … the list goes on.

They all felt such severe anxiety and “stage fright” that some even abandoned their craft for a period of time. (Surely our stress is no greater than theirs.) It seems elementary, but in fact simply acknowledging that you are experiencing anxiety or stress and giving it a name allows you to contain it, wrap your mind around and it and deal with it.

Once you admit you are experiencing stress then it is time to attack the problem that is causing the anxiety! Unlike in football where defense wins games, in life, offense (taking action) can often be better than defense (reacting).Do not run away from the thing causing you anxiety. Mentally, it will only make you more likely to fear it and will create a bogeyman that will be hard to deal with.

Give the problem a name and identity. Then figure out a way to deal with it.

Remember to emphasize your priorities and minimize the rest

Maintaining a singular focus on the most important things in your day-to-day life and not dwelling on minutiae and time fillers is important. Too many of us get bogged down with completing tasks that are neither urgent nor important and usually both. By focusing on the one or two things each day that are most important, you will be more productive and the rest will either usually get done in the process or will show themselves to not even be worth doing. That alone will decrease your stress levels.

Develop a routine

I personally do not care what routine you develop per se, because anything is better than complete chaos. Think of infants – having raised several of them, people (including my parents) are astounded that they all slept through the night from a young age. What’s the secret? A routine. Every day we did the same thing, feeding them at regular intervals and then performing a bedtime ritual that would trigger them to recognize “Hey it’s time to go to bed”.

The same thing applies in our own lives. You want to minimize the variables because that will create familiarity and comfort. Professional athletes are notorious for being superstitious and having quirky pregame rituals – Wade Boggs a hall of fame baseball player used to always eat chicken before a game. Every time! Tiger Woods always wore a red shirt on Sunday during tournaments. These rituals help to prime the athlete for the competition and their performance. They help to “anchor” them and restore a productive mindset, despite what is going on all around them.

Another contemporary example is Raphael Nadal. His prematch rituals are legendary. Ever watch him serve? He goes through a lengthy pre-serve ritual where he touches various parts of his body and bounces the ball numerous times. He constantly tugs on his shorts, his shirt, his hair. These quirky behaviors are actually his way of resetting his state of mind so he can perform as well as possible. They may seem strange but you cannot argue with the results.


I always thought meditation was for New Age wannabes with limited access to reality. But hearing otherwise sane, highly successful people like Howard Stern, Jerry Seinfeld, and Arnold Schwartzenegger rave about Transcendental Meditation and crediting the practice with helping them to succeed really made think twice about it and want to learn more. I am by no means an expert on meditation but from my own experience, (and according to more and more research), it works.

A doctor holding a yoga mat

Daily meditation, even for a few minutes can do several things. It can help you limit the negative emotions swirling in your head by training the mental muscles that help you focus. For me, that is the real benefit. There is probably no difference to the various forms of meditation (you can do a simple breathing exercise without needing to contort yourself into some bizarre praying mantis pose). The key is just to do it.

I do a very basic breathing meditation usually for 5-10 minutes during my lunch break. I simply focus on my diaphragm expanding and contracting. Within a few seconds, thoughts and ideas start popping in my head and then I simply refocus my consciousness on my breathing. Not only do I feel more refreshed after doing this, it definitely has helped to increase my ability to focus at will (and therefore limit stress). And this is all without buying into any of the mysticism some choose to associate with it.

Practice your craft

When we look at people who succeed at the highest levels, they all describe some variation of the state of flow. Mihaly Cziskentmihalyi is a sports psychologist who helped popularize the science behind the flow experience, i.e. the experience where the subject is so engrossed by the activity and so focused that they don’t even recall what was going on in the background. One of the most famous examples of the flow state, was Michael Jordan in the NBA Finals against Portland Trailblazers in 1992. In what is sometimes referred to as “The Shrug Game” Jordan scored 35 points in the first half, with 6 3-pointers. He was completely unstoppable. Even he couldn’t believe it when he thought about it– which is why he gave a shrug after another one of his three pointers went in. That is definitely a flow state.

Everyone thinks that it comes easy for the pros (or the best in whatever field of endeavor you choose). But this is an illusion. We only see the results of hundreds, if not thousands of hours of practice beforehand. If we saw all those hours spent honing their craft, no one would think that it was easy. Practice makes perfect is the old adage– but it also allows for things to flow effortlessly. When you are consciously thinking through the steps in your golf swing or talking yourself through a free throw you invariably create hiccups that can affect the results. When you have prepared yourself, through practice and repetition, you can do things more effortlessly, which will make things less stressful.


I never kept a diary or a journal growing up though it always seemed like something a creative or important person would do (at least the romanticized version). Then not too long ago I thought about developing ways to improve my creativity and I came across a book called “The Artist’s Way” by Julia Cameron. In this book the author advocates for two things to improve your creativity and imagination– daily journaling, first thing in the morning before anything else, which she called the “Morning Pages” and an “artist’s date” (basically a block of time you devote to exploring things that can trigger creativity). I never did the second but I definitely did (and still do a version) of the first. It is incredible how important simply writing your thoughts on paper can be.

The clarity you can gain by doing this is immense. I can’t stress enough how simply putting thoughts, ideas, anxieties, and fears on paper can make them so much more manageable. In addition, I think that doing this exercise first thing in the morning before anything else really helps to access the subconscious part of the mind that is working on solving problems in the background. With clarity and focus, your fears and anxieties will start to disappear. Try it. It actually works.


Here is something I like to do before an event or activity that I am anxious or fearful of. Take for example a particular surgery – one that is exceedingly difficult and risky. I will close my eyes, usually right before bed and visualize the exact scenario playing out in my mind. Literally, as close to the real thing as is possible to imagine. I have the music in the background. I have the usual staff. The patient is positioned and draped. I see myself in the first person and perform the actual procedure step by step. I sense my breathing and my posture. I feel my confidence. I walk myself, in my mind, through the procedure. No rushing, no cheating. Exactly as if I were doing it right now, for real. It is incredible how helpful this one exercise has been for me. It can make a procedure or activity that is unfamiliar, feel so much more natural when you actually do it.

If you have never done this before just try it next time you do anything that you have been dreading. I have even used this for my jiu jitsu sparring – this has really helped me accelerate my progress even without spending the usual amount of time on the mat, simply because I am getting the reps in my head. And when I walk onto the mat I feel much more confident.

This is simply a brief overview on ways to manage stress but in future posts we will delve deeper into some of the key elements and exercises discussed here and go into further depth on the actual step by step processes.

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1 comment
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