We’ve always known that extreme stress brings on the fight and flight response. It is now acknowledged that there are probably four other dimensions.  In addition to fight and flight, one also has fright, freeze, frantic and fatigue.

The above responses are hard-wired in humans and animals for survival of the species.  However, to have these responses constantly in our everyday lives is not so useful, and certainly not much fun. For doctors who have upcoming written and/or clinical exams, their bodies activate at just the thought of an exam.

We all react differently to fear, especially in the oral exams. For instance, with

FIGHT you may react defensively to an examiner’s questions.

FLIGHT you may gabble anything just to finish and get out of there.

FRIGHT you may feel weak and shaky, and your voice doesn’t work well.

FREEZE your brain seems to go numb and you just can’t find the words.

FRANTIC is when you feel totally overwhelmed, and

FATIGUE is just a feeling of being flat and having extreme tiredness.

At different times you may have any one or more of these responses. It really depends on the environment, your previous experiences, and your personality.

However, if you practise the various exam components regularly under pressure, at home under simulated exam conditions, you can become more familiar with recognizing when excessive stress is starting to impact on your performance. By taking a diaphragmatic breath when you recognize that your body is tightening up, and your mind is starting to race, you can usually manage to take control and increase your focus on the task.

One major stressor for doctors is constant fatigue. This fatigue can be managed if you follow a few guidelines.

1. For instance, drinking water throughout your shift is important for hydration. That’s one hint that savvy athletes always follow, to avoid excessive fatigue.
2. If you take medications check the fine print just in case there is another reason for feeling so tired.
3. Make sure you eat foods that keep your iron levels up, especially for females.
4. Reduce your sugar intake. You’ll have less brain fog as sugar impairs communication between your brain cells. Reducing your sugar intake will strengthen your memory and learning abilities. Keep in mind that eating sugary treats before bed causes blood sugar levels to rise and keep you up longer.
5. A light, high-fibre, low-fat meal at night leads to better sleep – metabolism of high energy foods at night increases core body temperature, leading to disturbed sleep.
6. Another major reason for not sleeping well, is using your smartphone, computer or iPad, or watching TV right up to bedtime. If possible, turn off these devices an hour before bed, as the blue light these devices emit may be suppressing your body’s ability to secrete melatonin, a sleep hormone. Make a habit of disconnecting well before bedtime.

However, I know that sometimes you may have urgent preparation for a presentation the next day and must use computers etc. right up to bedtime. Try orange tinted glasses – orange lenses block the melatonin-robbing light coming from your devices so you can sleep better at night, and feel more energized in the morning.  I believe you can find orange or amber-lens glasses online.  Wear them for at least one or two hours before bedtime. I believe some tablets and laptops now have orange-coloured backlights for screen viewing.at night.

There are several things you can do to improve the quality of your sleep.

1. Try and have a milk drink sometime before bed. It contains tryptophan, a sleep-inducing a-amino acid that is used in the biosynthesis of proteins.
2. Also, if you have a bath or shower before bed, start off with the water really hot to try and increase your core temperature, then rinse the skin with cooler water just before you dry off. This encourages better sleep.
3. Sleep in a cool, dark, and well-ventilated room.
4. If you have just come off night shift and have to sleep during the day, take five minutes to sit out in the sunshine, before you go to bed.

Swimmers and water polo players have learned to use these strategies when they compete at night and need to sleep during the day.

In summary, these are just a few hints for busy doctors who need to deal with exam stress, constant fatigue, and lack of sleep.

Be mindful, it’s worth it!

Dr. Patsy Tremayne

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