Physicians are constantly exposed to various types of stress. The definition of stress is the sequence of events that occur when perceived threats chemically activate the body's fight or flight response.

The source of stress may be the desire to always have the perfect clinical outcome regardless of the medical condition being treated. Physicians tend to be perfectionists, and hence, we get stressed out when the outcome is not what we expect.

Another steady source of stress is navigating the constantly changing bureaucratic environment in which we work. We are expected to keep abreast of a myriad of new policies and information, while also integrating those changes into our own medical practice, which can take a tremendous amount of time and energy.

Stress may also arise from our personal lives. When physicians and medical students spend increasing amounts of time in professional pursuits, we may not find enough time to attend to our personal interests and life.

According to Roy Meninger, MD, of Meninger Foundation, physicians tend to be self-sacrificers and may feel guilty about paying attention to personal needs. Some may neglect relationships and develop what he calls "psychology of postponements."

In researching methods of stress reduction, I found a number of practical ideas. They are:

Exercise. This is not only about working out hard, but also allowing time for the body and mind to refresh and recover. Exercise includes stretching and relaxation techniques.

Sleep. Adequate sleep is very important. Establish a regular sleep time and take 20 to 30 minutes of quiet time before going to sleep.

Flexibility. Keep an open mind. There may be more than one way to tackle a task.

Sense of Humor. Make a conscious effort to be amused. Take your responsibility seriously, but take yourself less seriously.

Be Your Best Friend. If you make a mistake, learn from it. There is no need to be overly self-critical. Base your self-esteem on what you do have control over, not on the results.

Be More Than a Physician. Don't put all your identities in one basket. Each person has various identities, e.g., physician, spouse, parent, etc. Nurture all these identities.

Listen and Communicate. Listen and develop trust. Become aware of your feelings and get comfortable describing them.

Work the Internet/Inner-net. A visiting scholar from India said: "We all use the Internet to connect with each other. We connect across oceans, continents and cultures. It is an informative highway, and we should use it. The inspiration highway, on the other hand, is a bridge across our own ego, fears and desires. We need a strong connection to our inner-net to have joy, peace and prosperity.

"The inner-net can be activated in a number of ways. You can go to your mentor or spiritual leader or practice silent moments in meditation. These techniques are frequently used in the Eastern cultures with good results. You may choose to go to a yoga or meditation teacher who can help you connect to your inner-net. Once you have developed this connection, you will always want it to be turned on."

For more information on physician well-being, visit www.meaninginmedicine.org or www.physiciansguide.com.