An Important Question

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Lots to Consider

When determining a patient's diagnosis and plan of care, there are many things that a health care provider considers. For example, a typical "History & Physical" in the hospital includes the following information:  

• Patient's age, sex, race
• Chief complaint (the problem that brought them in)
• History of present illness (description of signs/symptoms, when it started, events surrounding symptom onset, severity, what makes it better/worse)
• Review of systems (systems may include: constitutional [such as fever or weight loss], head/ENT, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, skin, neurological, psychiatric, endocrine, hematologic/lymphatic, allergic/immunologic)
• Past medical history
• Past surgical history
• Family history (illnesses that run in the family)
• Social history (family/job situation, smoking, alcohol use, illicit drug use)
• Medications
• Allergies
• Misc. (depending on the situation, things like immunization status, recent travel, etc.)

And these are just the questions asked. This list doesn't include the things we do to get more information. Things like:

• Taking vitals
• Performing a physical examination
• Ordering and interpreting tests (labs, imaging, EKGs, etc.)

My point is, there is a lot we must learn about a patient, and a great deal of that information comes from the questions we ask. 

An Important Question

Of the many questions that I ask patients, I've found that there is one question that frequently holds a key piece of information.

This question tends to bring up a lot of emotion. In fact, I have seen it bring tears to many patients' eyes. Of course, I don't ask it to cause tears. I ask it to gain insight into the patient's state of health and well-being.

That question is, "How is your stress level?"

People are stressed. They are stressed about work, stressed about finances, stressed about their family and friends, stressed about commitments and obligations, stressed about problems going on in the world... The list goes on.

For so many reasons, many of us feel stressed. 

What You Should Understand About Stress

Why do we stress? When faced with perceived danger, the body's sympathetic nervous system is activated. This is also known as the "fight or flight" response. Heart rate, breathing rate, and blood pressure go up. Adrenaline, cortisol, and glucose levels rise. For thousands of years this sympathetic response has helped humans to outrun a predator or fight for their lives. This response can enhance performance and improve chances of survival.

In today's modern world, a great deal of the stress we face is psychological stress. This can be from acute events (ranging from acute emotional trauma to fast-approaching work deadlines) or from chronic stress (such as ongoing feelings of worry, overwhelm, or powerlessness). Although psychological stress does not present the same kind of immediate physical danger as being chased by a predator, the body's reaction to it is similar. And over time, this can lead to physical problems.   

Stress affects our body's ability to work well and naturally heal itself. Our bodies have many natural healing mechanisms in place for self-repair. Although the stress response can improve performance during times of danger, chronic stress can negatively impact the body's ability to heal itself. In other words, the stressed state is not a good healing state.

Chronic stress can contribute to a number of medical conditions, including hypertension, increased inflammation (which has been linked to heart disease), gastrointestinal problems, chronic pain, and a weakened immune system (which compromises the body's ability to fight off infections and cancer). 

Stress is about perception. The degree of the body's stress response does not necessarily correlate with the seriousness of an event. For example, one person may be extremely stressed because their house is a mess, while another person may remain calm after being told they've lost their job. The way we process life's events determines our stress response.

What can we do about stress? The good news is that there are several things we can do in our daily lives to decrease the body's stress response and improve our health. The Internet offers many resources on stress management, including this resource from the American Heart Association. 

Dr. Vivek Murthy, US Surgeon General, has given an excellent TEDMED talk related to this subject. I highly recommend watching this 12.5 minute presentation. He explains how unhappiness (which stems from stress, worry, anxiety, isolation, lack of meaning, and loss of self-worth) is a risk factor for illness. On the other hand, happiness (which stems from emotional well-being, fulfillment, purpose, connectedness, and love) is a powerful tool for health.

He explains how practices such as gratitude, meditation, social connectedness, and exercise are simple and accessible ways to improve our health, as well as the health of those around us.

Taking Action

I encourage you to check out this powerful talk, and to consider some practices you could implement in your daily life, to minimize the effects of stress and improve your state of health. 

This post was originally published on March 3, 2017.

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