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McPherson et al’s article  generates some interesting questions
concerning disproportionately high levels of psychological distress
amongst Emergency Department (ED) Senior House Officers (SHOs). The
combination of shiftwork, a challenging working environment, broad case
mix, and newly acquired decision latitude may explain the findings.
We did have some reservations about the article...
We did have some reservations about the article. We are unfamiliar
with the General Health Questionnaire (GHQ) and brief COPE questionnaire.
A more detailed description and explanation of terms would have been
valuable. We felt that SHOs on nights (if not those on holiday) should
have been included to reduce sample bias. Confining the study to units
based in DGHs raises questions regarding generalisation. It would have
been interesting to know the degree of shop-floor senior cover in the
units studied, and to examine whether this influenced distress levels.
How can we apply this useful work to our own practice? If we
acknowledge the core finding, and accept that there is a problem amongst
our junior colleagues, we then need to ask whether intervention is
required. SHOs are required to have regular contact with a consultant
supervisor, but there is potential tension between the roles of
supervision, and support. Formal mentoring schemes offer an alternative,
but their value in the ED has been questioned. It may be that the best
way to support SHOs is to be aware of their potential vulnerability to
psychological distress, and to encourage a team-based and pastoral
atmosphere within our departments. This will allow individuals recognising
a need for support to seek it out from for themselves, from people who
they feel are appropriate for the problem in hand. This is the approach we
have, in the past, taken within our own unit. However, as a response to
this article we will incorporate a session on stress management into our
SHO teaching, perhaps in conjunction with administration of the GHQ and
brief COPE …. once we find out more about them.
(1) Mcpherson S, Hale R, Richardson P, Obholzer A. Stress and coping in
accident and emergency senior house officers. Emerg Med J 2003;20: 230-231.
(2) Mentoring senior house officers. Is there a role for middle grade
doctors? Okereke CD, Naim M. Emerg Med J 2001; 18:259-262