By: Alicia Jerome MS, RDN
Medical events can be traumatizing to patients, and it is important to recognize contributing factors and treat the whole patient. What had been planned as a normal hospital delivery quickly spiraled into a placental abruption, life-saving hysterectomy, ICU stay, and pneumonia. A week later, MH, a 20-something new mom, leaves with hormone replacements, care for recovery, and a brand-new baby. Recovery is slow and on top of the demands of being a new mom, wound healing, and lack of sleep there isn’t much time to process all that happened. MH is tormented by the loss of not bearing any more children, redefining herself as a woman without her reproductive organs, emerging anxiety and depression, conflicted emotions toward her doctor who acted as her savior and perpetrator, and the frustration of a husband who wasn’t able or equipped to deal with strong emotions. The fallout from the patient’s perceived trauma of this medical event is what is called medical trauma. Five years later, this woman comes to your nutrition clinic asking you for help with her weight gain and compulsive eating. The first step toward helping her recover is identifying the contributing underlying issues. Medical trauma is just beginning to be explored for its possible impacts. It can be short term or contributed to life-long impacts.
What is Medical Trauma?1
Essentially, any medical-related event in which the patient perceives trauma, and it impacts other areas of their life can constitute medical trauma. Medical trauma doesn’t have to be invasive either. An adult who had an insensitive or aggressive doctor or orthodontist as a child, and now, is afraid of getting medical or dental care has experienced medical trauma.
Another example is having a life-threatening or altering diagnosis: A 55-year-old woman receives a phone call that indeed the lump in her breast is cancerous. A dad of three boys is diagnosed with Parkinson’s disease. In both instances, the person may become distressed, take out anger on others, avoid being with friends and relatives, see themselves as less of a person than before, isolate themselves, and so on.
Medical trauma can stir up a variety of reactions. It has been found that people, based on their personality traits, coping skills, perceptions, and past experiences deal with trauma in a variety of ways along a spectrum from mild upset to anxiety and depression, up to post-traumatic stress disorder (PTSD).
Trauma impact can also be divided into two categories: primary and secondary crisis
Primary crisis includes immediate physical and emotional effects. Physical effects may be painful surgery or physical therapy, burns, wounds, altered physical abilities, and side effects from medication. Emotional crisis can include sadness, anger, worry, and fear.
Secondary crisis is a result of a primary crisis and it develops through the patient’s own meaning and context. Here are some of the ways a secondary crisis may manifest:
- Relational: the stress from medical trauma can dissolve marriages and friendships.
- Developmental: some people will redefine their role and remap their direction in life.
- Identity: people experience a loss in who they planned to be. For example, a man had a motorcycle accident and could not work in construction—his vocation, which resulted in an identity crisis.
- Spiritual: it is not uncommon for people to question and lose faith (even temporarily).
- Leisure: one may intentionally or unintentionally abandon favorite activities.
- Financial: hospital bills continue to build and can cause financial ruin and bankruptcy.
What Can a Health Practitioner Do?
Good health practitioners can, of course, help prevent trauma from happening again, and identify previous trauma by including a few of the following techniques. This is by no means an exhaustive list.
- Understand that there may be underlying agendas happening that neither you nor the patient may be aware of, for example, a woman coming for weight loss stopped losing and we realized she was sabotaging herself. Years before when she was recovering from breast cancer, women in her support group did better through radiation and chemo when they had some extra weight. She was in remission, but just in case it ever came back, she didn’t want to be too thin. This awareness came after eight nutrition visits.
- Provide good communication: use empathy, speak slowly and clearly, bring warmth to every interaction.
- Manage your own emotions and inquire about the patient’s emotional state.
- Include a trauma screening checklist in consultations.
- Assess the areas of secondary crisis (see above).
- Refer patients to trusted counselors or utilize in-house mental health professionals.
- Ensure the entire healthcare staff has empathic communication training.
- Develop protocols for responding to patient distress.
- Give consistent support to both the patients and their families.
- Suggest a nonmedical adjunct support service such as Cancer Support Community (CSC) or Diabetes Hands Foundation.
As medical trauma becomes a more common term and enters medical conversations more and more, we can each consider if we are part of the problem or solution. How can each of our interactions with patients, clients, their family, and friends be empathetic, supportive, intuitive, and move the needle away from medical trauma?
Reference:
Hall, M. F., & Hall, S. E. (2017). Managing the psychological impact of medical trauma: A guide for mental health and health care professionals. Springer Publishing Company.