August 2007, Volume 57, Issue 8

Letter to the Editor

Psychosocial support programme to reduce stress among Emergency Physicians

Muhammad Shahid  ( Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Suite E-8624, 615 North Wolfe Street, Baltimore, MD 21205, USA. )

Madam, During recent years many doctors were kidnapped for ransom, target killing, and other atrocities' therefore physicians are concerned about work place violence. Emergency Physicians (EPs) are the front line doctors for managing acutely sick patients such as sudden deaths, road traffic injuries, bomb blast victims, gun shot injuries and patients with different medical and surgical emergencies. Moreover, ethical dilemma of breaking bad news to family and/or to the patients also remains mainstay of EPs? They face a lot of stressors like work overload, lack of support and supervision by senior consultants, dealing with difficult patients, conflicts with paramedical staff and home related conflicts.3 In addition to this work related stress, irregular social and family life is the main component of ongoing burn out process in these professionals. EPs should be well equipped for the disasters in terms of further strength building and coping emotionally with mass casualties hence rescuing themselves as well as others 4
Long working hours in the Emergency Department (ED) is reported as one of the reasons for stress and fatigue.5 Timing of interns, residents and senior medical officers working in ED therefore should be reduced. EPs do not earn enough money in Pakistan to support their families and go overseas to work. Their salaries should be increased so that they should work in their own country. ED should arrange different functions for their staffs like picnics and parties and more frequent breaks be given to them. This will help them in rejuvenating themselves and prevent them from burn out.
EPs should work as a team, understand each others problem and help each other. They should take care of themselves by taking good balanced diet, adequate sleep (atleast 8 hours) before coming to job, relax and make a habit of exercise. This will help in keeping them active both physically and mentally. They should not approach the disaster scene until the appropriate authorities have declared it safe.
They should enjoy their normal hobbies and activities and celebrate different occasions happily. EPs should learn brief relaxation techniques including breathing exercises and progressive muscle relaxation. They can relax by listening to music, reading a book, cooking, and spending time with family and friends. More EPs should be appointed, in order to reduce the overall duty hours and work load at all levels. The above suggestions will help reduce stress in EPs working in stressful conditions of EDs.

Muhammad Shahid
Department of International Health, Johns Hopkins University, Bloomberg
School of Public Health, Suite E-8624, 615 North Wolfe Street, Baltimore,
MD 21205, USA.

References
1. Gadit AA. Back to Pakistan. BMJ Careers 2006;333:179.
2. Khuwaja AK, Qureshi R, Andrades M, Fatmi Z, Khuwaja NK. Comparison of job satisfaction and stress among male and female doctors in teaching
hospitals of Karachi. J Ayub Med Coll Abbottabad 2004;16:23-7.
3. Baig A, Siddiqui I, Naqvi H, Sabir S, Jabbar J, Shahid M. Correlation of serum cortisol levels and stress among medical doctors working in emergency
departments. J Coll Physicians Surg Pak 2006;16:576-80.
4. Gadit AA. Disaster, mental health and rescuing medical professionals. J Ayub
Med Coll Abbottabad 2005;17:1-2.
5. Heyworth J, Whitley TW, Allison EJ Jr, Revicki DA. Correlates of orkrelated stress among consultants and senior registrars in accident and emergency medicine. Arch Emerg Med 1993;10:271-

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