A qualitative study of how doctors use impression management when they talk about stress in the UK

Objective: To examine how junior doctors talk about experiences and perceptions of stress in order to better understand the socio-cultural influences of stress in medical education. Method: In depth semi-structured interviews were conducted with 10 doctors who were at the end of the first year of the UK Foundation Programme (FY1, equivalent to the intern year). A discourse analysis approach was used to analyse the findings. Results: Participants were found to typically normalise, deflect or trivialise their own experiences of stress. Consistent patterns of talking about stress; ‘busyness’, ‘patient responsibility’ and being the ‘good doctor’ were identified. These patterns formed interpretive repertoires that can be viewed as functioning as a form of impression management. The repertoires allow doctors to talk about their views and experiences of stress as a wider professional issue, without risk of being judged on how an inability to cope with stress might reflect on their own performance as a doctor. Conclusions: Consistent patterns of talking about stress exist in medical education and shape individual and organisational responses. Doctors who are not coping with stress may risk increased harm by not seeking help as a consequence of prolonging attempts to maintain the impression of coping. Greater sensitivity is required where stress is simply constructed as an environmental factor or where those who admit to not coping become marginalised. Medical educators require greater awareness of the dominant stress repertoires employed within their organisation.