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Pulling our lens backwards to move forward: an integrated approach to physician distress
  1. Sydney Amelia McQueen1,
  2. Melanie Hammond Mobilio2,
  3. Carol-anne Moulton3
  1. 1 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Carol-anne Moulton, Department of Surgery, University of Toronto, Toronto, ON M5S, Canada; Carol-Anne.Moulton{at}


The medical community has recently acknowledged physician stress as a leading issue for individual wellness and healthcare system functioning. Unprecedented levels of stress contribute to physician burnout, leaves of absence and early retirement. Although recommendations have been made, we continue to struggle with addressing stress. One challenge is a lack of a shared definition for what we mean by ‘stress’, which is a complex and idiosyncratic phenomenon that may be examined from a myriad of angles. As such, research on stress has traditionally taken a reductionist approach, parsing out one aspect to investigate, such as stress physiology. In the medical domain, we have traditionally underappreciated other dimensions of stress, including emotion and the role of the environmental and sociocultural context in which providers are embedded. Taking a complementary, holistic approach to stress and focusing on the composite, subjective individual experience may provide a deeper understanding of the phenomenon and help to illuminate paths towards wellness. In this review article, we first examine contributions from unidimensional approaches to stress, and then outline a complementary, integrated approach. We describe how complex phenomena have been tackled in other domains and discuss how holistic theory and the humanities may help in studying and addressing physician stress, with the ultimate goal of improving physician well-being and consequently patient care.

  • medical education
  • health care education
  • medical humanities

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  • Contributors All authors have met all four authorship criteria and have approved of the final draft of this manuscript.

  • Funding SAM is an MD/PhD student supported by the McLaughlin Centre MD/PhD Studentship and the Canadian Institutes of Health Research (CIHR) Vanier Canada Graduate Scholarship. This research was funded in whole, or in part, by the Wellcome Trust [grant number 204770/Z/16/Z].

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.