At a Critical Crossroads: Post-Traumatic Stress or Post-Traumatic Growth for Healthcare Providers
While conducting rounds on the adult cancer unit, our team stopped outside a patient’s room for the intern to present. But he was nowhere to be found. As the attending physician became impatient, the intern ran up with a shocked look on his face. The attending angrily asked where he had been. The intern solemnly stated, “I just saw Dr. Peters jump off the 15th floor balcony of the hospital.” As a third-year medical student on the team, I immediately felt faint and confused. Our attending replied, “That’s a shame. He was a sick man. OK, on to the next patient.” There was no hesitation, no pause to process what we had heard and what this poor young physician witnessed. I stood there silent like an obedient student following my mentor’s example and continued with my work, never to discuss this tragedy in any formal way.
We physicians are trained in solving problems, swallowing emotions, and moving on to the next task at hand. For those of us raised as male in American culture, this is reinforced by what we’ve been taught our entire lives. This can serve us well when handling emergencies and making fast decisions to save lives. But when compartmentalization extends to everything we do, day and night, the vicarious trauma we absorb never gets processed. We end up overwhelmed, isolated, and burned out.
The COVID-19 Pandemic has been the most far-reaching global medical crisis of my lifetime. For all of us in healthcare, constant stress and uncertainty flooded our days. We’ve been called to risk our lives while caring for patients, risk our families’ lives as we potentially expose them to the virus, and attend to the emotional needs of critically ill and dying patients while their families are prohibited from hospitals. The direct and secondary trauma we’ve experienced has not been fully processed either individually or collectively because that isn’t part of our culture.
Most mental health professionals believe the next pandemic we will face is one of widespread mental illness among healthcare workers with many abandoning medicine altogether.
It doesn’t have to be that way. We are at a crossroads in healthcare with one path leading to a pandemic of post-traumatic stress and another heading toward a renaissance of post-traumatic growth. If we ignore the emotional impact of our experiences, we will go down the first path. If healthcare institutions likewise continue to ignore their responsibility to create supportive healthy work cultures, they will pave the road to a mental health crisis. However, if we all acknowledge the trauma and work together to process and learn from it, we can create positive life-giving work environments, leading us to a better place where investment in our own well-being results in improved patient care and professional fulfillment.
The AMA’s Steps Forward Program suggests several successful, evidence-based interventions for institutions to support the mental health of their providers. Many of them are as basic as leaders showing up and asking front line staff how they can be better supported.
https://edhub.ama-assn.org/steps-forward
The Institute for Healthcare Improvement (IHI) synthesized all the research published in this area in their article “Psychological PPE: Promote Healthcare Workforce Mental Health and Well-Being” which is available on their website.
In addition to improved institutional frameworks, individual providers must attend to their own emotional, physical, and spiritual needs before giving so much of themselves to others. Research has shown that the more self-aware and self-compassionate we are, the better healers we become. Physicians in my coaching programs often note that our self-care practices help them listen and connect with patients in a healthier way and still have energy for family at the day’s end.
Many still hesitate to seek out formal mental health treatment because of the possible impact on licensing and hospital staff applications. This sad reality is gradually changing for the better as states eliminate application questions regarding mental health treatment. As a flexible alternative, professional coaching has assisted many physicians in enhanced well-being and performance and been proven to decrease burnout and improve resilience and quality of life. (JAMA Intern Med 2019;179(10):1406-1414)
Imagine a supportive health system where after Dr. Peters jumped off the 15th floor, the attending physician showed the same degree of shock and emotion we all felt, counselors met with each team member present that day, and all doctors, students, and staff members gathered to process the experience together.
Better yet, imagine a world where Dr. Peters never felt the need to jump.
Joe Sherman, MD is a pediatrician, professional development coach, and consultant to individuals and healthcare organizations in the areas of cross-cultural medicine, leadership, and provider well-being. His mission is to help health professionals rediscover the joy of practicing medicine. Reach him at joe@joeshermanmd.com
