Sydney McQueen, MSc, PhD, MD

High rates of distress among surgeons, and physicians more broadly, are alarming and negatively impacting provider wellness, performance, and healthcare system functioning. Yet despite increased attention, we continue to struggle in addressing stress in practice. One challenge is the lack of a shared vocabulary for understanding stress, which is a complex and idiosyncratic phenomenon that can be experienced both positively (as eustress) and negatively (as distress). While traditional reductionist approaches focusing on individual facets –such as physiology or cognition– have greatly advanced scientific knowledge, stepping back to examine the composite, subjective experience of stress may provide new, complementary insights for mitigating distress and supporting more favorable states in practice.

This research program explored the multidimensional, integrated experience of stress among academic surgeons in order to establish conceptual frameworks for understanding surgeon distress and eustress in practice.

Qualitative data were collected over three phases, guided by a constructivist grounded theory methodology. Semi-structured interviews were conducted with staff surgeons affiliated with the University of Toronto, purposively sampled to capture a broad range of perspectives including specialty and experience level. 

Eustress and distress were reconceptualized as multidimensional experiences, comprising physiologic, physical, cognitive, affective, social, cultural, and environmental facets. Subjective control was identified as central to the stress experience. In contrast to traditional dichotomous views placing eustress and distress on two polar ends of a spectrum, findings illustrated how experiences of distress and eustress could overlap and coexist. Conceptual frameworks were established for understanding eustress and distress, and how physicians might reflect on their own experiences in practice. 

Stress is not simply positive or negative, cognitive or physiologic, or individual- versus system-based; understanding the points of intersection and seeking to embrace inherent complexities in the subjective human experience may provide deeper understandings and allow us to approach stress in a more authentic way. 

This research was supported by CIHR Vanier Canada Graduate Scholarships, The Princess Margaret Cancer Foundation

Cover image by Douglas Buller