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Posttraumatic Stress Disorder in Emergency Medicine Residents

      The emergency department (ED) is an environment of high intensity and stress for all its staff members. In addition to the daily challenges experienced in the ED, emergency medicine resident physicians are also regularly exposed to trauma, illness, death, and violence, which compose the primary triggers for the development of posttraumatic stress disorder (PTSD). They are confronted with these difficult scenarios and tragedies from the onset of their training, leaving them prone to the emotional effects. The terms burnout and depression are often discussed and dissected in relation to physician well-being; however, PTSD may be a more applicable concept than we realize. In fact, physician PTSD has become a new topic of investigation, and with good reason.
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      Linked Article

      • Posttraumatic Stress Disorder in Emergency Medicine Residents: A Role for Moral Injury?
        Annals of Emergency MedicineVol. 72Issue 3
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          We read with interest the perspective piece on posttraumatic stress disorder in emergency medicine residents in the United States.1 The addition of the new exposure criteria to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,2 those of witnessing events or being exposed to aversive details of these traumatic events, would lead us to consider many emergency medicine and out-of-hospital care practitioners to be potentially at risk of posttraumatic stress disorder.
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      • In reply:
        Annals of Emergency MedicineVol. 72Issue 3
        • Preview
          Thank you for your fascinating response to our article. We agree with the notion that moral injury as described by Shay1 and Litz et al2 occurs in emergency physicians. Physicians grapple regularly with a sense of personal failure in believing they could have done more despite knowing that medically nothing further could have been done to help a patient. The dissonance between what a physician feels, ie, guilt, and what a physician knows can be overwhelming. This can even lead to self-doubt and questioning of one’s decisions despite following best practices: that sense of “What if I missed something?” or, worse yet, “If another physician were in my shoes, would the patient have been better off?”
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      • In reply:
        Annals of Emergency MedicineVol. 71Issue 4
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          The authors thank you for your commentary on this article.1 We appreciate your acknowledging the importance of the issue of posttraumatic stress disorder in emergency physicians and the necessity that we seek ways to improve physician well-being. Your perspective as mental health professionals is critical and helpful to our cause.
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      • Posttraumatic Stress Disorder in Emergency Medicine Residents: A Reply and Caveat
        Annals of Emergency MedicineVol. 71Issue 4
        • Preview
          We read with great interest the timely review by Vanyo et al1 that highlighted the routine exposure of emergency medicine providers—particularly medical residents—to trauma, illness, death, and violence, and the resultant risk for the development of posttraumatic stress disorder (PTSD). Investigating the effect of traumatic stress among providers is an important step in improving their welfare and, potentially, the care patients receive. Left untreated, PTSD is a debilitating, chronic condition.
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