Amy Brann  00:00

Stress, it has become such a constant pressure that many of us barely notice and wait until it’s affecting our sleep, our health and our peace of mind. But when does stress go from just being part of life to a sign that it’s actually time to seek help? In this episode, we’re breaking down the real impact of prolonged stress on your mental and physical health, your relationships and even your decision making. And we’re going to answer the common questions, when is it time to talk to a doctor? What options are available for managing stress? And just as importantly, what can we do to build resilience against stress in a world that’s always on from physical symptoms to emotional overload, will guide you on recognizing when stress is no longer a manageable solo activity, and what tools your GP might offer you, beyond the mythical magic wand to support you back into taking control. Sometimes asking for help with stress isn’t a sign of weakness, it’s the smartest move that you can make for your health.

 

Dr. Jessie Gulsin  00:57

Thank you, Amy, I think this is a really important and relatable subject. I mean, I don’t know about you, Amy, but there are some days I haven’t even stepped into my room at work, and already my cortisol is through the roof, you know, doing the school run. And so stress is something that affects all of us. And I’m sure, as you’ve gone around to various organizations with your work, you’ve been asked many questions about it, so share with us the kind of questions that people ask you about it.

 

Amy Brann  01:27

It is a topic that comes up really frequently. I think it hasn’t left many people untouched, either through personal experience or through loved ones becoming stressed and it being hard to manage. People ask things like, I’m feeling really stressed, should I see a doctor? Or I’m waking up in the early hours of the morning and I can’t sleep, should I see my doctor? Will they be able to help? Or people often share that their job is really stressful, or some other aspect of their life, it might be their relationship, might be their health, and say, you know, can the doctor give me something to help So, huge range of different questions, but quite often asking like, should I be able to cope with this, or should I be seeking medical intervention?

 

Dr. Jessie Gulsin  02:13

And so, why is it so important to understand when we should be seeking help for stress?

 

Amy Brann  02:19

Well, I know, with your medical hat on you will see the impact of stress, whether we can clearly link it to that cause or not. But we’ve got physical and mental health implications. If we’ve got prolonged chronic stress levels, we see it contribute to mental health disorders, anxiety, depressions, but also all of these physical ailments like heart disease, high blood pressure, even weakened immune function. So there are also other impacts that perhaps we think less about, but our decision making and ability to focus can be impaired when we’re in high stress situations, and today, a lot of organizations have got a very fast pace to them, so making quick decisions that we can also rely on is really important, and if stress is well managed, then people can be more present, make clearer decisions and plan more effectively so that they can get through this mountain of tasks. But then there’s also the emotional impact and the relational impact of stress. Certainly I am more irritable when I’m stressed, and it’s really noticeable if I’ve got something playing on my mind, and then I’m with my daughter or with my husband, I know I can be snappy, and it makes it more difficult to connect with other people, and that erodes things that are most precious to us. So definitely the relational consideration and also just how we feel as a result of the stress. There’s implications there too. So I definitely think it’s worth tackling and being aware of, and I hope almost as a culture moving towards a place where we’re not just so accepting or dismissive of stress. You know, you and I talk on a regular basis and help to manage one another’s stress through being listening ears, but also sometimes offering advice. But if you were to put your GP hat on for a moment, what are some of the signs and symptoms of stress, and when would you want to see someone with some of these symptoms as a GP?

 

Dr. Jessie Gulsin  04:28

So stress can be quite insidious. I think, as I said, it affects everyone. We can all relate to feeling stressed, but sometimes we may not even be aware that we are at a point where we probably should be seeking some help and some support. So as a GP, I’d be wanting to rule out what we call any red flags. So, you know, is somebody depressed or having kind of really negative thoughts? Once I’ve kind of ruled those things out, there are a range of symptoms that people can present with which to me demonstrate that. Are stressed, but they may not even put a finger on it and relate their symptoms to stress. I mean, speaking from a personal point of view, similarly with I think you mentioned your daughter there with my son the bedtime gauntlet. You know that one more book mommy is really cutesy when I’m not stressed, but when I’m stressed, it’s really irritating, so I get very irritable. But it’s talking about kind of symptoms in kind of categories, I think about physical symptoms. So, oh yeah, my my eczema flares up, you know, I get headaches. I might just pick up every cold going. So these are the kinds of things that people might start to notice as subtle symptoms. People may get, kind of gastrointestinal upset. Their bowels may change. Psychological symptoms, wise, you might find that you’re at work and you just aren’t able to concentrate as well as you once could, and you are getting a bit more irritated with colleagues who are asking lots of questions. Again, I know that as a trainer in my practice, I’m constantly asked questions by trainees, and if I’m feeling particularly stressed, I may be less sympathetic when they are asking me back to back questions, memory, kind of issues, racing thoughts, all these kind of other cognitive symptoms, which, again, you may not necessarily think are related To stress and kind of behavioral symptoms. So if you’re noticing a colleague at work, for example, who may be neglecting responsibilities, turning up late, having more sick days than than they normally do, just withdrawing from social kind of activities, obviously, as a GP, I have other responsibilities, so I need to be checking in that patients aren’t, you know, having issues with drugs or alcohol, which unfortunately, sometimes can be where people lean towards, oh, you know, I’ll have that extra glass of wine tonight. It’s been a really stressful day, and that can be a bit of a slippery slope. So from my point of view as a doctor, we do have kind of objective tools and measurements that we can look at to identify when someone’s stressed, so from things like blood pressure being through the roof, but also just asking them specific kind of questionnaires. So there’s depressive depression questionnaires and anxiety questionnaires that we sometimes use and implement help kind of assess whether somebody’s at a point where they probably do need some help and intervention or not. So I think stress is something to just kind of be aware of. It may be that when you first kind of get to the point where you do need support, the next time that then happens, you’re able to recognize that sooner. But you know, from a point of view of kind of looking out for our colleagues in an organization that we may work in, it may be those kind of subtle things that you might notice about somebody that you know, that may be the only telltale that they’re very stressed. So yeah, it’s a tricky one. And as I say, some people don’t come to me with I’m stressed, Dr Jesse. They’ll come to me with lots of generalized, non specific symptoms, but it’s then opening the doors, and like you say, Amy, it’s, you know, times are changing in society, we are more open to having these discussions, which is so important.

 

Amy Brann  08:13

So some time ago, that’s really useful. And some time ago, we we worked with an organization, we did a webinar not too dissimilar to this, where we were talking about how managers could recognize stress in the people that were working with them. And one of the things that you said that really stood out to me was to be in tune with your colleagues and notice changes. So if they were very bubbly and now they were quieter, or if they were always on time and they’ve been late a few times, any changes, complaining more of some of those physical things that you’ve mentioned, or even their approaches to things and how they appraise a situation might shift from being a glass half full kind of person to having more of a negative filter. Are those things still sensible advice?

 

Dr. Jessie Gulsin  09:16

Yeah, absolutely. I think the problem is, when we’re all stressed, it’s, it’s a bit more tricky to notice the stress in others and and, you know, we’ve all got deadlines to meet work is, is, yeah, it is stressful at times. And I think sometimes it’s about taking a step back and recognizing that stress in yourself, definitely. But yes, if you do have colleagues who are not behaving how they normally would. I think it’s about showing a bit of compassion and just appreciating that perhaps there’s something more going on here, rather than their put you know, the performances is poor at the moment. You know, it’s looking at the bigger picture. What are they normally like? How. Is this different? And actually, I think sometimes we are fearful of coming across nosy or intrusive when we’re asking people how they are, and other times is, you know, we’re all guilty. I’m definitely guilty of it. You know, you ask the How are you question, but you don’t really have time to hear the answer. So actually, when you’re asking the How are you question, it’s about giving that patient, that patient or that colleague, the space to then answer that truthfully and honestly. And you know, as a side point, as a doctor, I have a responsibility to my patients to look after myself, because if I am not looking after myself, I can’t look after my patients. And similarly, in organizations, we all have a responsibility to one another to do that so to strike that work life balance, which can be very difficult. So I think that it’s really important to make time for yourself. I try to take time off every three to four months in my line of work, because I think that it can start to take its toll on me otherwise. And you know, when I say time off, have parent life isn’t necessarily time off, but you know, just having headspace away from work is just so important. And yeah, we’ll talk about tools and ways to manage stress in another podcast. But yeah, just really important to be aware of the signs and the symptoms which could indicate that you’re not you’re not quite yourself at the minute, and stress may be the cause of that.

 

Amy Brann  11:29

Yeah, that’s absolutely where we’re focusing today, because the tools and techniques that are evidence based, there are so many of them, but I’m really looking forward to talking about those another time with you. The what just jumped into my head there was, we’ve got a shared friend who had a holiday for the first time in about five years, two weeks ago, and she’s returned from holiday like a different person with particular mind frames completely changed, and she sounded so she’s really smart, and she she came back from the holiday, and she’s like this. Holidays made the world of difference. I think, I think we should all have them regularly. Of course, that is general advice, general wisdom, but it’s not what everyone does. So sometimes experience, isn’t it that sometimes we have to experience this difference to then make those different decisions in the future. There was this a very specific scenario jumped into my head, which I want to pick your brains about. There’s not going to be an answer to this, but a someone I was interviewing for the make your brain work book shared with me that one of her employees is really struggling at the moment. They were returning from mat leave, and things were really difficult, and they were feeling really low, and they’d obviously got the strength of relationship to be able to share their personal situation with their manager, but the manager was a little bit stuck. She says there are lots of things that we can do to support her when she comes back to work. We can change the working hours, we can change the job pressures. We can support her. You know, being good people, emotionally, we can rally around her. But how do I get her back? Because at the moment, she’s so overwhelmed, so overloaded, she’s been to see her GP, which is, which is great in this instance, but, but what can the manager do to try and get her back when she’s so overloaded. So I don’t know whether we can just brainstorm. Is there anything that comes to your mind that might be helpful in this sort of scenario?

 

Dr. Jessie Gulsin  13:47

Well, I think two things. Firstly, it’s just fantastic that her manager is being so supportive. You know, there will be countless women who can completely relate, myself included, who can completely relate to that. You know, year of maternity, if it’s even a year which isn’t a year off, it’s very stressful, and having to come back to work and the anxiety that comes with that, and the stress that can be associated with that. So the fact that her manager is being proactive here is just so amazing to hear. Secondly, I’m really pleased that she’s gone to her GP, because, as I say, with my doctor hat on, I’d want to be making sure that she isn’t suffering from something a bit more serious, like postnatal depression, and that she is is safe, from that point of view. So in terms of what the manager could do, well, I mean, first of all, she’s opened that line of communication. That’s the first step, isn’t it? And for that individual who’s going through what she’s going through, having that compassion being shown to to her is is going to be amazing for her. So it’s opened up lines of communication. I think it all depends on kind of the severity of her anxiety and what’s going on. So if it’s not something that is to the point of requiring more medical input, then I guess it’s a stepwise approach really. I mean, there’s lots of things that I can do as a doctor. There are things I can’t do. And you mentioned the magic wand earlier there. You know, I often do ask my patients that when I’m assessing things to do with their mood, not because I’m definitely going to be able to then give them what they’ve asked me for. I’m not a genie in a bottle, unfortunately, but it gives me an idea of what their baseline is, you know, if I could, you know, wave a magic wand, what would you like me to do? And then it allows me to see how much or how little we can then, you know, work with so as a doctor, of course, I can prescribe medications. There are medications available for anxiety and obviously depression. There are talking therapy, talking therapies and kind of psychological therapies available which I can signpost people and refer people to very skilled individuals who will give people time to kind of address some of these concerns in our area. We also can refer to the gym and get some exercise in the mix, which we all know is just such a fantastic way to boost our energy and minimize anxiety and try to mitigate some of the problems that can be associated with anxiety. It’s not something I’d always recommend straight off the bat, because if somebody is severely anxious or severely depressed, the last thing they want to hear from their doctor is get up and go to the gym. I can’t even get out of bed in the morning, Doc, so I’m not going to get to the gym. So you know, all all things are case specific. Of course I can sign people off work. It’s not always the right thing for people. It may be that that causes more anxiety for them. In the case of this lady who’s on maternity leave, she’s obviously got that extended period off, but when she returns, in conjunction with her kind of line manager, they could talk about a transition back to work, you know, easing her in like a phased return. And doctors can sign notes for such things. And then something which has kind of been more recent in the last few years, are social prescribers. So those are professionals working in GP practices who are able to sign posts to various community services. So for the for example, this lady, you know, perhaps you need to be put in touch with other young, other new mums, or other kind of groups which are going to kind of help bring her out a little bit. So there’s so much available. Obviously, as a doctor, I can’t take away and as managers, even you can’t necessarily take away the root cause of that stress. But there are ways which we can smooth the transition back to work, ways that we can help people. But really, you know, the first port of call is always going to be checking in with the individual, saying, We are here for you. We are here to support you. That’s just really important, isn’t it?

 

Amy Brann  18:01

Yeah, it is so important, and I think it’s brilliant to hear all of the things that are available to you as a GP that will and have supported and been a lifeline to many individuals suffering from clinical or sort of on the way to being clinical level disorders. Or challenges that are causing problems, I guess, on the non medicalized roots. In an ideal world, what would people have in their working life to support them. Do you think what would partner really well? Say someone is diagnosed with depression, has been prescribed some SSRIs and is wanting to return to work. Say that they’ve got their motivation has been boosted, possibly in part through being heard, listened to by a kind GP, but then also through the effect that the SSRIs might be having on them. What kind of environment would you love them to go back into, in a workplace to help them to really turn this around?

 

Dr. Jessie Gulsin  19:18

I think it’s really, it’s really going to be tailored for the individual, doesn’t it? It depends how we all like to work. I think if you’re somebody who there’s two things here, so you may return to work. So this, this lady who is currently off, may return to work and work completely differently to how she previously worked. I definitely know that when I returned to work after having my son, I I thought Blimey, I thought I was stressed at work. This is a this is a break for me. I get a hot cup of tea now it’s a wee on my own. They all. Depends on how how the individual works in the first place. So for example, if if you’re somebody who likes to be around other people, because it motivates you, and having that hive of activity is something that kind of keeps you alive and keeps you buzzing, then great. But if you feel like actually, that’s going to be really distracting for me, I need some quiet space. I need some time to reflect. Then, you know, having a different workspace environment could be beneficial, or having some kind of check ins throughout the day with your line manager, if there’s time for that. So the structure of the day, I think there’s, there’s so many things I guess you need to think about, but it’s all going to be very specific and tailored to each individual, which I know can sound like a lot of work for many. I can hear people thinking, but I don’t have time to, you know, tailor make this like workplace for this person. But actually, if you think about it, if you can ensure that your your kind of people are happy and feeling supported, then how efficient and effective are they going to be at work? If they don’t feel those things, then their performance will potentially decline as a result. So it’s short sighted to not tailor these kind of approaches. I think it’s just, it’s just one of those things you look after one another, and you’ll reap the benefits of it as a team.

 

Amy Brann  21:26

I agree. I think we have to understand what an individual needs. And I love the fact that you’ve highlighted that, you know, in this example, or, I think, with anyone that’s going through a time of challenge and stress what they needed before may be different to what they need now or in the future. I believe that the There’s windows of opportunity and there’s windows of increased plasticity, and from some of the studies I’ve read around SSRIs, they can offer one of these windows of opportunity, so your brain can become more plastic during this time, and so when you’ve then got the energy and almost a degree of positivity enough to get you started then being around people who can support the strengthening of those ways of thinking. Because stress is not stress is individual to each person. So what stresses you is different to what stresses me and what stresses me today might be something that I can totally take in my stride tomorrow, and so all of these factors in an ideal world would be taken into consideration to a degree so that, so that we can work best. But the bottom line is this, knowing who you’re dealing with and being compassionate to them. And there’s there’s studies that talk about the the impact of just being present and a listening ear to someone. And again, I’ve had a situation with a friend who was going through a tough time, and just being able to share that with close friends and us properly Listen, rather than jump in and try to smooth things over and Oh, come on, you’ll bounce back and it’ll be all right. You know, you’ve done this countless times before. Sometimes people really need something different, and they need to hear that you’re seeing them, you’re getting them, you’re understanding that this is serious and things are really tough. And we can do that. We should be doing that for our friends, but also in the workplace, that might be where your regular touch points are. You know, I don’t see you during the working week and during the year, I don’t always see you that much either. We do talk on a regular basis, so we’d probably tune into if anything major was going on for one another, but the people that you work with on a daily basis will have such an opportunity to positively or negatively affect how you’re doing. And one of the challenges a lot of organizations, I hear raise is that with the more hybrid, or even more virtual working that where before, the emotional contagion could be positive, and if someone was struggling, you could lift them up, and you could offer words of support and encouragement. If they are home alone, as it were, and struggling, it’s much harder to know that that’s the case and to G them up. And I know you you and colleagues at your surgery, sometimes hard things happen, and you are needing to be there for one another to help process and, you know, deal with the really snoot. Anti impatient people that you might see from time to time, that I’m sure some of us have even been from time to time. So yeah, it seems like there’s real opportunity for those that need to see doctors and to seek support through those routes, and then combine that with these supportive, compassionate workplaces who know that stress and a challenge in dealing with stress can strike any of us, absolutely

 

Dr. Jessie Gulsin  25:33

and actually, you know we mustn’t forget that some organizations may actually have in house counselors and therapists, and they are very skilled individuals, so I know that I talk to my friends to offload, but that’s that’s quite cathartic in a lot of ways, obviously, but they’re not, they’re not trained professionals. They can’t then help me work through things that maybe require that additional level of expertise. So it’s worth bearing that in mind. You know, does your organization have an in house therapist or counselor? Can they offer you some sessions, and if not, speak to your GP, we can signpost or refer you to these highly skilled individuals who will then be able to work through some of these things with you. It is definitely very helpful to chat to friends, and you have saved me a lot of money on therapy Amy over the years. But, yeah, I think, but I think it’s important to just, you know, be aware of what resources your organization might have which would be helpful.

 

Amy Brann  26:45

And have you seen any examples in the normal world where people might be having this positive, uplifting effect on people without even being aware of it? Maybe I’m thinking about a particular shop you might have visited at certain in your life.

 

Dr. Jessie Gulsin  27:04

Yes, I did wonder whether you’re going to bring this up. Okay, fine. I will dive old. So when I was when I was on maternity leave, those of you that have had children, or do you have children in your life, you know, you know they are quite a challenge sometimes. And I remember there were days where I barely brushed my hair and just about chucked some clothes on, and there was a lady in a local supermarket at one of the checkouts. And I’d always go to the same checkout lady, because no matter how I felt that day, no matter what I looked like, she would always tell me that I looked wonderful and that my baby was looking very healthy and I was doing such a good job, even though I felt like I really wasn’t doing a good job. So she has no idea to this day how much she actually helped me through that time of my life. And actually I probably should go and thank her, because she still works there. So I think that kindness can come in many guises. And yes, she probably doesn’t realize the impact that she had on me over those many months, on a serious note. And so, yeah, I think that it’s something for us all to just be a bit more aware of having a few kind words. You just don’t know the impact that that’s going to have on someone.

 

Amy Brann  28:21

I think it’s so good to highlight these kind of things. Jess because she had an opportunity, she didn’t necessarily realize the impact of her opportunity, but you remember her to this day, and that’s amazing, the positive impact she could have with very little cost to her. It was a relatively easy thing to do. There’s a lovely lady local to me who runs a community center, and she’s got such a heart for the local community, but she doesn’t even realize the impact she has. Sometimes, unless people loop back to her, and she had this older gentleman one time come into the center, and the center’s attached to a church, and he, he said, Oh, can I, can I just sit in the church for a while? And the policy is, unfortunately, that the church is is locked most of the time, unless there’s events going on in there. And she said, Oh, I’m really sorry. I can’t let you into the church, but you can come through here, where there’s a there’s some chairs and there’s a kitchen. She said, Let me make you a cup of tea. And she made him a cup of tea, and she sat with him for a little bit, and then she said, Well, I need to go back to my my work now, but feel free to sit here as long as you want. And some some groups started. People came and went, and then he left, and she didn’t see him again until a couple of weeks later, when he came back in and he said that day, I was feeling absolutely awful. I was really low, and I was I was planning to kill myself, he said, but the kindness that you showed me and the acceptance just the welcome, seemed to turn it over. Around for him, and after that, he started coming to some of the groups at the community center, and you just think she could have dismissed him. She could have said, no, sorry, the church isn’t open. Come back on Sunday, which would be rather conflicting with a church’s message. But she didn’t, and and that meant a lot to him, and I’m sure the ripple effect of the family and things. So again, I just don’t think we know all of the opportunities that we have to make positive differences to people.

 

Dr. Jessie Gulsin  30:34

How amazing, how amazing. And literally life changing for that chap. And it cost, it cost her nothing. And in terms of time which we all stress about not having enough of, literally less than five seconds of her time. Oh, that’s amazing. What an uplifting way to end this conversation. Thank you for sharing. No

 

Amy Brann  30:56

you too. I think, yeah, good to better opportunities out there in life to be positive influences on others. Well, if you enjoyed today’s episode, please do share it with a friend or colleague who might find it helpful. It’s one of the best ways for us to grow and reach more people like you. Make sure you’re following us on your preferred viewing or listening platform, so you’re first to know when new episodes are released. You