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The article by McPherson et a1 generates some interesting questions concerning disproportionately high levels of psychological distress among emergency department senior house officers (SHOs). The combination of shift work, 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 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 district general hospitals 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 among 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 emergency department has been questioned.2 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 permit doctors recognising a need for support to seek it out 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.