Dr. MacDonald - Stress

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Background Information

After a busy weekend on call, Dr. Rioux, the Chief Resident recounted to the Chief of Service, Dr. Wilmot, some concerns about Dr. McDonald, the junior resident. During the first week on the surgical service, Dr. McDonald\x{2019}s performance was outstanding and no problems were anticipated for the rest of the rotation. Over the last three weeks, his performance was more spotty and Dr. Rioux attempted to talk to Dr. McDonald, who stated that she/he did not see any problems with her/his interactions with patients.

More concerns were noted during the weekend on call. Dr. McDonald arrived late for rounds, looking tired and dishevelled. He did not follow up on patients' x-ray results and blood work as requested by Dr. Rioux.

During an emergency procedure for bowel obstruction, Dr. McDonald asked to leave to go to the washroom but did not return to the operating room. Dr. Rioux, the Chief Resident, seemed annoyed at Dr. McDonald and came to ask Dr. Wilmot, the Chief of Service, for assistance in dealing with this junior resident.

The next day, Dr. Wilmot spoke to Dr. McDonald. Dr. McDonald again looked dishevelled and avoided eye contact with Dr. Wilmot. When asked about her/his performance, Dr. McDonald denied any problems and stated there was a personality conflict with the chief resident. Dr. McDonald stated that due to the excessive demands of the chief resident, Dr. McDonald was not able to see her/his family, causing undue family strains.

Dr. McDonald couldn't remember the last time that she/he had had a good night's sleep but was sure that with a couple of early nights and something to help her/him relax, the problems would go away as long as the chief resident eased up and had more realistic expectations.

Three weeks later, Dr. McDonald comes to the nursing station and belligerently asks for the lab results on a patient. When the nurse responds that the test wasn't ordered, Dr. McDonald makes a derogatory comment about the incompetence of nurses. The nurse thinks she/he notices the smell of alcohol and comments to a colleague about Dr. McDonald's continued unkempt appearance, erratic behaviour and forgetfulness.

PCL learning Issues

Each student should pick 3-4 objectives for research and discussion on stress-related behavioural issues.


Discuss "normality" (determined by oneself, by others) for behaviour, personality, rationality, cognition etc

Sleep requirements and functioning

Common stress-related issues in the workplace broadly and, more specifically, in the the health-care profession

Stats and risk factors

Incidence and prevalence of substance abuse in health professionals

  • outcomes
  • a role for psychological testing/evaluation?
  • what treatments are available?


The spectrum of stress: is there 'healthy' and 'unhealthy' stress? How are they recognized?

Appropriate and inappropriate coping strategies for stress (work related & personal)

Functioning under stress: personal issues, work, abused substances, mental illness

Illness (and other) consequences of poor performance

Discuss the perception (among the public and profession alike?) that doctors are "strong" and "should put up with their stress"


Impact of stress on personal/family/career life. Is this improved/worsened in a relationship between two physicans?

How does one approach a friend/colleague suspected of having difficulties?

  • who should be approached? When would you help?
  • physician responsibility in regard to threat to patient care
  • patient/physician boundaries
  • role of confidentiality

Additional stressors/issues associated with being a member of a minority group?


Psychologists and psychiatrists in health care. What are the roles?

Stigma of mental illness and marginalization of the mentally ill

Hierarchy within hospital/healthcare profession staff

Who helps/protects students, residents, physicians with personal difficulties?

Physician health strategies and programs