10 Things to Know About Stress

Stress is unavoidable in emergency medicine, and performance depends less on eliminating it than on appraising it correctly and responding well. Acute versus chronic stress, perceived control, and perfectionism all shape burnout risk, while practical ED habits can turn stress into something more usable.

Stress Appraisal and Coping

• Threat versus challenge appraisal: Stress is filtered through appraisal: the same event can feel like a threat or a challenge, and that framing strongly shapes performance, emotion, and downstream coping.
• Acute and chronic stress: Acute stress is immediate and situational, while chronic stress lingers over time; distinguishing the two matters because they call for different coping responses.
• Control and stress load: Perceived control has an inverse relationship with stress, so restoring even small areas of choice can reduce overwhelm and improve day-to-day resilience.
• Eustress versus distress: Not all stress is harmful; eustress can sharpen focus and support peak performance, a useful distinction when high-stakes clinical work is the norm.
• Perfectionism as vulnerability: Perfectionist thinking treats anything short of flawless as failure, making clinicians more stress-reactive and more likely to generate unnecessary suffering for themselves.
• Cathartic expression habits: Talking things through or writing privately can lighten cognitive load and improve coping after difficult events. We get into the practical version in the episode.

Stress Management in the ED

• Stress inoculation rehearsal: Mental rehearsal before high-stakes, low-frequency events builds familiarity under pressure and can make real-time stress feel more manageable in the resuscitation bay.
• Pre-shift arousal control: A consistent pre-shift routine helps regulate arousal and creates a sense of readiness before the department starts dictating your attention.
• Compartmentalization between encounters: Deliberately resetting from patient to patient, or from home to work, helps prevent emotional spillover and limits cumulative stress across a shift.
• Positive self-talk cues: A brief cue word or meaningful phrase can interrupt negative spirals and redirect attention toward productive action. We lay out how to build one in the chapter.
• Excellence over perfection: Aiming for excellence rather than flawless outcomes preserves accountability without tying self-worth to factors you cannot fully control in emergency care.
• Burnout and disengagement: Disengagement can become self-reinforcing: once clinicians detach, performance and satisfaction both erode, making attitude and team environment operationally important.

References:

1. Link to Dr. Stankovich’s blog:  Stress: 10 Fast Facts You Need to Know for Improved Mental