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STRESS & ATLS or ACLS research

Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR trauma-list@trauma.org
Wed, 5 Jun 2002 14:15:04 +0100

The research question is an interesting one: are ATLS/ ACLS courses more
stressful than real life situations. If they are, clearly it cannot be by
reproducing real life well- it must be because of a stress created by the
course. This is unlikely to be a good predictor of stress in real life
situations. We all respond to different stresses differently- I've seen
doctors who perform well and remain cool in real life situations go to
pieces when presented with written exams. Mike Tyson clearly appeared under
stress and agitated when being interviewed, yet seemed to be able to cope
with the stress of the world's hardest hitters trying to know lumps out of
him in a boxing ring.

> I have no idea what you are talking about.   I know of no 
> one who is 
> really
> active in trauma, critical care, or major surgery who even 
> uses the word
> stress. 

I know a few who use it. Maybe different language across the pond. I've also
seen a lot of doctors from critical care, trauma and major surgery who
develop the adverse effects of stress/ abnormal coping strategies (excess
drug and alcohol consumption, extramarital affairs, divorce etc.)
> For those who choose a 
> career in 
> cardiac,
> vascular, trauma or surgical critical care, STRESS IS THE 
> I would never hire a person who during the 
> interview
> even mentions the work "stress."   For that matter I dont like 
> the terms
> "life style," "vacation", "post call" and other terms which are self =
> centered, and
> not patient care and patient outcome centered.

Again, differences across the pond. Pretty common in interview here (for
posts in high adrenaline specialities) to be asked: 'How do you deal with
stress'. Personally I'd reckon that someone with outside interests is less
likely to burn out (or worse, as I've seen people do, not mention stress
then either start making strange decisions or suddenly throw down tools,
swear at the nurses and storm out of the resus room).
A child dies in front of you- if you don't find that unpleasant there's
something a bit odd about you- and that something probably doesn't make you
a better doctor. You either consciously recognise that unpleasantness (and
I'd call it stress) and deal with it or you don't. I'd rather have a doctor
who dealt with it.

> Many surgeons actually have a lower pulse rate and blood 
> pressure when the 
> case is at its most critical point.

What is the physiology behind this? Is it a vagal response?

> I am tonight watching 
> Game 6 between 
> the Lakers and the Kings.   Shaq O'Neal does not look 
> stressed at all, but 
> victorious.  

Ah, sport. Something I know a little about. One of the coolest international
rugby forwards I have ever seen used to vomit before every game. Felt
stress, responded, dealt with it and then went out and did the job. No
worries. (Actually, same thing in performance arts- singers and ballet
dancers can appear under tremendous stress before they go out- pale, sweaty
palms, pacing up and down etc., then go out and give an incredibly
controlled performance). I also note you do have an outside interest- would
you not employ yourself if you mentioned this at the interview or am I
misunderstanding your post?

Matt Dunn

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