Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

I experienced trauma working in Iraq. I see it now among America’s doctors.

Elizabeth Métraux
Physician
April 9, 2018
Share
Tweet
Share

STAT_Logo I was on my honeymoon in Colombia when I first became aware of the true extent of my post-traumatic stress disorder. My husband and I were walking across a smooth, granite platform to take a closer look at a fountain in downtown Cartagena. As we neared the structure, mist from the fountain’s jets dampened the ground at my feet.

I froze, paralyzed with fear by a flashback — my first — triggered by something as ordinary as wet pavement on a warm day.

Two years earlier, I was working in civic engagement efforts in Baghdad. One morning, as I walked across a smooth, granite platform toward my apartment, gunfire erupted. I tried to run, but my flip-flops bested me on the pavement, still damp from an early mopping. I slipped and fell backward, hitting my head hard enough to knock me out. When I opened my eyes minutes later, the platform was covered with my blood.

That happened 15 years ago this week, those Ides of March when American forces invaded Iraq.

Back home in the U.S., it was clear to those around me that I had PTSD. It wasn’t until six months after my honeymoon, however, that I had the courage to acknowledge that I needed help. It’s not easy seeing your own weaknesses, much less conceding them. But when my habitual glass of wine with dinner became a bottle, and fireworks left me sore and sleepless for days, it was hard to fight the signs.

Celexa for guilt. Ambien for sleep. Therapy for months. My psychologist and primary care physician spoke regularly to coordinate my care. Most importantly, family and friends became members of my care team. Isolation is a trauma victim’s ill-advised drug of choice, one my loved ones and clinicians wouldn’t let me take.

Trauma in health care

Some people who contract a disease become experts in it. I’m one of them. We obsess over the research. We learn the signs and symptoms, and develop a private language with our fellow patients. We learn each other’s triggers and tactics, like an army of code talkers who just … know.

Which is why today, as a health care advocate who has struggled with PTSD, it’s clear to me that many of our country’s health care providers are struggling with trauma, as well. And we’re doing little to support them.

A few weeks ago, I was talking with a physician who served our country in Iraq. We chatted nostalgically about the taste of sand and shawarma before he said something that gave me pause: “You know, I’d go back to the field any day. Beats practicing in my clinic.”

“Why’s that?” I asked.

“I didn’t become a doc to put up with billing codes and power struggles. I thought that PTSD would hit when I came home from Fallujah. It’s so much worse when I come home from the office. Truth is, I’ve lost my sense of purpose.”

That struck a chord.

Clinicians are experiencing epidemic rates of what we casually call “burnout,”with such symptoms as fatigue, irritability, and stress — like we’re talking about the trials of new parenting.

But there’s something beyond burnout happening in health care today. More than half of primary care physicians are at the end of their ropes. Nearly 1 in 3 resident physicians have symptoms of depression. One in 10 medical students have thoughts of suicide. They’re not stressed out or, as my family was fond of saying about me, “adjusting.” They’re experiencing trauma — that loss of meaning cited by the army medic.

“Tiny betrayals of purpose”

ADVERTISEMENT

Clinician burnout is frequently chalked up to the eight-minute visits with patients, the six hours spent each day entering data into electronic health records, and the demands of a profession where life-and-death decisions must routinely be made. But this short list of factors doesn’t get to the real wounds of practicing medicine .

In an article in the Atlantic, Dr. Richard Gunderman offers a more nuanced breakdown of causation. He notes that “burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. [Physicians] find themselves expressing amazement and disgust at how far they’ve veered from their primary purpose.”

Gunderman isn’t the first to explore the cumulative impact of these “tiny betrayals of purpose.” In his book “Achilles in Vietnam,” Dr. Jonathan Shay, a psychiatrist who studied Vietnam veterans, made the case that actions that contradict an individual’s core purpose — either compulsory or voluntary — can result in a kind of “undoing of character.” For clinicians, much like combat veterans, these violations of character can build up, with damaging consequences.

It’s not just the eight-minute visit: It’s that an eight-minute visit means physicians can’t provide whole-person care to patients whose diagnoses aren’t easily logged into a computer. It’s not just the six hours of daily data entry: It’s that it takes clinicians’ eyes off their patients, missing the very connection with humanity that drove them into this work. And it’s not just the problematic quality metrics that physicians are subjected to: It’s that those metrics have crowded out deeper connections with patients to help them manage triggers and navigate treatment.

During grand rounds at Duke University School of Medicine, Dr. Andrew Morris-Singer, a leading voice on physician burnout and an advocate for primary care reform, remarked that the state of the system is resulting in a generation of clinicians practicing medicine “in a manner inconsistent with their values.” The results of this inconsistency can be fatal. More than 400 providers take their lives each year — an industry suicide rate second only to the armed forces. If thatdoesn’t compel us to act, then the impact of burnout on patients should ignite a national conversation. Clinicians with mental health challenges make more mistakes, take more sick days, are less engaged in their work, and are less empathetic.

It’s time to call burnout what it really is: trauma. As I and so many others who have experienced trauma have come to realize, its sufferers don’t always see the signs. Health care providers are no different. Others need to help them see what they are experiencing. That job needn’t fall solely to their family members or colleagues. Patients — you and me — need to step up and call it out, to demand action by health care organizations to address it, and to offer a community of care that serves as a powerful antidote to isolation and retreat.

If we don’t, if we continue to disregard the epidemic of trauma among our physicians, lives — of patients and providers — will be unnecessarily lost.

During a panel at last year’s Aspen Ideas Festival, Morris-Singer offered a simple challenge: “The next time you wrap up a visit with a health care provider, ask him or her, ‘How are you doing?’”

I echo that. Let’s start a conversation with our health care providers and listen, really listen, to their needs. As William Osler, father of modern medicine, famously remarked, “Listen to your patients. They are telling you their diagnosis.” Clinicians, too, are telling us their diagnosis. It’s time we responded.

Elizabeth Métraux is director of marketing and communications, Primary Care Progress. This article originally appeared in STAT News.

Image credit: Shutterstock.com

Prev

Why your physician wellness programs aren't working

April 9, 2018 Kevin 15
…
Next

Why cataract surgery is more complicated than it should be

April 9, 2018 Kevin 11
…

Tagged as: Hospital-Based Medicine, Primary Care, Public Health & Policy

Post navigation

< Previous Post
Why your physician wellness programs aren't working
Next Post >
Why cataract surgery is more complicated than it should be

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Elizabeth Métraux

  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • Medical schools need to produce more clinician-activists to help drive social change

    Elizabeth Métraux
  • Inaction is driving our collective burnout

    Elizabeth Métraux

Related Posts

  • Why do doctors who hate being doctors still practice?

    Kristin Puhl, MD
  • Doctors: It’s time to unionize

    Thomas D. Guastavino, MD
  • Why is trauma activation so expensive?

    Skeptical Scalpel, MD
  • When doctors are right

    Sophia Zilber
  • We’re doctors. We signed the book.

    Jonathan Peters, MD
  • Why doctors-in-training need better nutritional education

    Abeer Arain, MD, MPH

More in Physician

  • The man in seat 11A survived, but why don’t our patients?

    Dr. Vivek Podder
  • When did we start treating our lives like trauma?

    Maureen Gibbons, MD
  • Medicalizing burnout misses the real problem

    Jessie Mahoney, MD
  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

I experienced trauma working in Iraq. I see it now among America’s doctors.
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...