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Managing stress


Building resilience

Sources of stress


Case: Child with abdominal pain
Tired-looking male physician resting against a window frame

Background

A resident on her emergency medicine rotation assesses a young girl complaining of abdominal pain. After the initial history and physical examination, she believes the young girl looks well, has no signs for concern on physical examination and is likely suffering from constipation.

She discusses the patient with the emergency physician, who asks pertinent questions.

Knowing the resident's clinical skills and level of training, he believes she has assessed and diagnosed the patient properly. He does not personally examine the patient, telling the resident to discharge her home.

Outcome

The patient was readmitted the following morning with peritonitis from a ruptured appendix.

Think about it

  • Is this a likely scenario in a busy emergency department?
  • How would you feel if you were the resident in this situation?
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Sources of stress for medical students, residents, and practising physicians include:

Biological

  • fatigue, due to hard work and lack of sleep
  • lack of exercise
  • poor eating habits
Psychological
  • personality traits — highly responsible, conscientious, sense of guilt, compulsive, able to delay own gratification
School and work
  • studies and exams
  • call schedules
  • heavy workload
  • serious illnesses and/or social circumstances of patients
  • solving ethical dilemmas
  • interpersonal disagreements
  • conflicts
  • adverse events (accidents in Québec)
  • complaints or lawsuits
Personal
  • financial pressures
  • personal relationships
  • family needs