Dr John Lockley explains how stress can often be significantly reduced by only a small reduction in the work demanded of us

Mr Micawber was one of Charles Dickens’ fictional characters. Always on the verge of bankruptcy, his famous adage was: ‘Annual income twenty pounds, annual expenditure nineteen pounds nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery.’

From this, we can conclude that the difference between happiness and misery isn't twenty pounds, but (in old money) just a shilling.

This all sounds rather obvious, doesn't it? Surely this isn't particularly relevant to modern-day medicine?

Think again…

Mr Micawber's dictum applies not only to money but to any resource. Consider time, we're all short of it. What happens if just one extra patient has to be added into the middle of the morning surgery list? The clinician feels pressurised, that's what.

By comparison, what if just one patient fails to turn up to a fully booked clinic? All the pressure is off, the doctor can relax! She's got time! And all because she's gained not an hour, not even half an hour, but just 10 minutes.

The same is true of time across the entire day. If the clinician is asked to put 8 hours and 5 minutes’ worth of work into an 8-hour day, she will feel constantly stressed, especially if she is hot-desking and has to vacate her seat as the hour chimes.

By comparison, if she is routinely asked to do 7 hours and 55 minutes' worth of work in that same 8-hour day, she will feel much more relaxed about it.

The bottom line

The bottom line is this: Mr Micawber's dictum tells us that when we are working near capacity, even the smallest additional demands on our resources—whether money, time, staff, transport, parking spaces, rooms, or access to the computer—may tip us over into stress through not having enough of that resource to be able to cope properly.

The really practical aspect of this is the opposite: a small reduction in the demands made on us may remove the stress completely by taking us back below the break-even point.

Now clearly, if we are wildly overburdened a small reduction in demand won't do much. But in practice it doesn't tend to work like this, simply because at times of over-commitment, the moment we go over the break-even point (which perhaps we ought to think of as the 'tipping point') we suddenly enter a zone where the level of stress ramps up hugely despite there being a relatively small rise in the absolute demands upon us.

The practical aspect of Mr Micawber's dictum is this: a huge amount of stress can suddenly afflict us if we are only even slightly over-committed. By the same token, if this happens, we can massively reduce our perceived level of stress by slightly reducing demand— or alternatively, increasing (again, just slightly) the resources we can call upon.

Shaving Mr Micawber!

I've previously described ways of saving small amounts of time (‘shaving time’), and how these could add up to quite significant chunks if you play your cards right. There's a wonderful extra benefit to this that emanates from Mr Micawber's dictum. Even if the total time you save doesn't add up to a huge amount in absolute terms, if by shaving time you've now gone below the tipping point, then suddenly the pressure will be off.

I can't emphasise enough what a difference this can make to your work. If you can shave off a little here or there—from a financial cost, from the time taken, from the resources needed—then you may well go below the break-even point and reap benefits on a scale far beyond what you might have believed was possible.

Imagine that you have devised a system whereby you can create and print off routine patient recall letters slightly more quickly than in the past. The staff member responsible for these letters is now less pressurised—but more than that, if they have finished early they may not need their desk, workstation, or printer, thus relieving the pressure on these resources as well. They might even be able to vacate the room.

Don't just take my word for it: try it yourself. Almost certainly, you'll start by thinking of the ridiculously minuscule effect of saving a few seconds on a task, or an odd pound or two, or of slightly reducing the overall demand on your staff. Soon, however, you will discover just how much freedom it gives, how much bigger you perceive your resources to be, and above all, how much less pressurised everything becomes.

Sometimes it needs only a slight decrease in demand or increase in resources—of time, money, staff, space—to effect a huge change in the pressure you and your staff feel from your work and your working environment. And with reduction of pressure comes a reduction in stress and an increased sense of work fulfilment—something that's been sadly missing from primary care for many years. Shaving time in the right places, easing the pressure ever so slightly, ditching a little bit of unnecessary work, making things slightly more streamlined; each of these may bring things back below the tipping point and make all the difference between a job you hate and one you love, or as Mr Micawber so rightly said, between misery and happiness.

Key points

  • The difference between excess demand and working comfortably is often tiny
  • It may take only a slight increase in demand or a slight reduction in resources to change a job you love into one that wears you out
  • Look for those occasions when making small changes can take you back to the good side of the tipping point. These occur much more frequently than you might imagine!