Too often, trauma research focuses solely on impact on patients in health services—especially people who experience mental illness, trauma, substance use disorders, and homelessness. We need to expand the research questions to include the following: How does trauma impact physicians and what are the implications for their relationships with patients?
Trauma exposure is common among the general population. Similarly, vicarious trauma is real and affects physicians and medical staff in healthcare settings. If physicians are affected by trauma, they may need trauma services. Physicians with untreated trauma responses may also experience re-activation such as hyperarousal, dissociation, and flashbacks. Traumatic stress reactions can lead to barriers in relationships and communication with patients. Physicians can learn ways to cope with their responses.
Self-protective solutions to deal with the impact of vicarious trauma may be seamlessly weaved into physician’s responses to patients. The perception of a patient who is in distress can activate physician’s post trauma responses. This can affect the physician’s understanding of the person he or she is caring for, impact medial decisions, and interfere with compassionate responses. Learn more about the impact of racial bias in healthcare settings.
Perceptions of a patient’s motives and actions are filtered through the physician’s trauma lens. Like all survivors of trauma, a physician’s actions can be driven by automatic self-protective responses and leave him or her unable to see the unique qualities of and connect with the patient. As trauma reactivation infiltrates perceptions, patient care may suffer. It does not take a huge leap of faith for one to envision that vicarious trauma may lead to distortions that impair understanding of the patient as well as their motives and behaviors.
Physician trauma re-activation does not automatically lead to compassion and mutual understanding. As a trauma survivor, when my traumatic responses meet my doctors’ traumatic responses, the resulting perceptions can lead to distortions and difficulties in communication. If a physician and I get locked into trauma memories, they may distort our interactions and lead to poor decision-making. Additional research is necessary to understand how to break this cycle.
When a physician’s trauma inserts itself into the clinical setting, the physician may be unaware of his or her responses and how they affect patient care. Harry Stack Sullivan wrote about the physician as a participant observer. The physician and patient both contribute to the relationship and to ways of communicating. Research and evaluation of both parties can only clarify and add the pieces to the puzzle of how to build mutually respectful and successful relationships in healthcare!
Learn more about trauma-informed care by registering for t3's upcoming course: "Bringing Trauma-Informed Care to Everyday Practice."
Image by Tom Hart (CC BY-SA 2.0).
