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Join us for an insightful podcast episode with guest Kara Wada, a board-certified academic adult and pediatric allergy, immunology, and lifestyle medicine physician. Together, we explore the profound impact of disconnection in our modern existence, particularly within the physician-patient relationship. Kara shares her experiences and sheds light on the challenges faced by both patients and physicians in the current health care system. We delve into the importance of restoring healing connections, building trust, and fostering compassionate communication. Kara’s expertise in lifestyle medicine and her personal journey as a patient add a unique perspective to the conversation. Don’t miss this engaging discussion as we explore ways to enhance the synergy between patients and physicians and promote a more connected and compassionate health care experience.

Kara Wada is a board-certified academic adult and pediatric allergy, immunology, and lifestyle medicine physician, Sjogren’s patient, certified life coach, TEDx speaker, and Dr. Midwest 2023. She can be reached at Dr. Kara Wada and on Instagram, YouTube, Facebook, and LinkedIn. She is a national expert, sought-after speaker, advisor, and host of the Becoming Immune Confident Podcast. She is CEO and founder, The Crunchy Allergist and the Virtual Sjogren’s Summit, and serves as the director of clinical content for Aila Health.

She discusses the KevinMD article, “Healing clinician-associated trauma: a call for connection.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Kara Wada. She’s an allergy, immunology, and lifestyle medicine physician. Today’s KevinMD article is titled “Healing clinician-associated trauma: a call for connection.” Kara, welcome back to the show.

Kara Wada: Thank you so much for having me back, Dr. Kevin.

Kevin Pho: So Kara has been on several times before. Just go to KevinMD.com/podcast. In the upper right-hand corner, there’s a search icon. Click on that, and you can hear Kara’s story from her prior episodes. So let’s jump straight into your current one, “Healing clinician-associated trauma: a call for connection.” How did your article come together?

Kara Wada: Well, at the time when I was writing it, which was back in February, I was finishing up an eight-week course to become more trauma-informed and to learn how to actually mitigate, or lessen, the potential for creating more trauma within my practice of medicine. I was reflecting a lot on my role, both as a physician but also as an autoimmune patient, and on the increasing number of patients that I’m being referred who have been on what seems like this endless diagnostic odyssey, trying to figure out what may be causing the constellation of symptoms they may be suffering from.

Kevin Pho: So what exactly does it mean to be trauma-informed, for those who aren’t familiar?

Kara Wada: So it’s really taking pause and recognizing that each of us, going through life, has difficulties that we experience, and those difficulties have the potential to leave a lasting impact, not only on our brains but also on our bodies, in how we show up and interact with the world. So when we hear that term of someone becoming triggered, or I prefer using the word activated, it’s really these situations, maybe when we’re early in life or have experienced something that is frightening or challenging, or that triggers that fight-or-flight response, where we find ourselves back in that physiologic state. We’re not able to use our full humanness. We’re really functioning from that survival mode.

And it’s not uncommon for many people who have chronic health conditions, or who have interacted within the health care industry, to have had circumstances that may be traumatic, whether it’s a blood draw that didn’t go well or a near-death experience. Or in many cases, for patients who are marginalized or have symptoms that are hard to describe, hard to maybe understand, or don’t fit a check box, it may be an interaction with a clinician that didn’t go well, that was more adversarial.

Kevin Pho: So you mentioned that you did take a course to be more sensitive to the trauma that you see in the exam room. So tell us some of the things that you learned and some of the things that you are doing differently after taking that course.

Kara Wada: I think really the big thing is realizing that all of us have experienced trauma in some way, shape, or form. We don’t make it through life without having some difficulties or some experiences that our life sees in that way. I think that recognition is huge. The other piece that I think is really important is to respect that our patients come to us with their lived experiences, and we cannot take for granted that they are going to trust us right off the bat. We need to realize that we need to earn that trust.

The other thing that’s really important is learning and realizing that when we’re functioning at our highest level, the best way we can respond to things that maybe don’t make sense, or aren’t really fitting quite the paradigm we’re thinking about, is to really respond with curiosity and compassion, because this is really going to help continue that dialogue with our patients. And last, one of the best ways that we can help those who have experienced trauma is really restoring agency and their autonomy in that shared decision-making process, as we are making decisions about what might be best for them with whatever situation is going on.

Kevin Pho: Now, can you share a story, example, or case study where you could implement some of these things that you just talked about in your exam room? What would be an example of that that you could share?

Kara Wada: Yeah, so I have one from yesterday. I had a patient who came to see me. Commonly, as an allergist-immunologist, I have patients who are wondering if they have maybe a new food allergy. They eat a particular food, or several types of foods, that seem to cause symptoms or create symptoms after they eat them. And the reality is, for most of those adults, those symptoms are not true food allergies as per an allergist’s definition. They’re not anaphylaxing. But that doesn’t mean that they aren’t experiencing problems with digestion or other symptoms related to that food.

And so this particular patient came in for that complaint yesterday, and I just let her share her story. I gave her that five minutes to just tell me, “How did you end up here?” And it turns out I was like the 10th doctor she had seen. She had had difficulties with perimenopause symptoms and changes in her digestion, and I just gave her that space to share. I also restated back what she was experiencing and provided some context to it. And after she had kind of told me that I was the 10th person she had seen, and so on and so forth, I also shared with her, “I don’t expect you to trust me off the bat. I understand, or I would guess, that you have had some interactions with the health care system that have not always been positive.”

And honestly, just me saying that brought tears to the patient’s eyes, and not tears of sadness, but tears of feeling seen and recognized, and that she had been heard. It was something so simple, and it took no more than an extra 60 seconds, but I think it brought our relationship much closer than had we just continued on, or done a few skin tests, said, “Hey, you’re not allergic,” and moved on.

Kevin Pho: Did you get a sense of what her interactions were with the other nine clinicians that she had seen?

Kara Wada: At the time, she was experiencing significant brain fog, fatigue, and lots of vertigo-type symptoms, and not surprisingly, those are not easy symptoms to evaluate. They can be caused by many different things. And when she mentioned those interactions, she said things would often be dismissed as related to her weight, or, “Are you just anxious?” She was kind of brushed off, with the blame put on other potential causes, rather than anyone really listening and hearing what she was most worried about, which at the time was the impact of perimenopause symptoms on her health and the symptoms she was experiencing.

Kevin Pho: In your article, you write how the current health care system isn’t really conducive to encouraging patients to share their stories. Talk more about that.

Kara Wada: I mean, the reality is I am super fortunate to work in a clinical space where I’ve been able to really advocate to keep my longer appointment times, in particular because I am increasingly being referred patients who have stacks of records, or a long story, such that it takes 60 minutes to do a second opinion for a patient with an immunologic problem. And the reality is that that is not the usual. The usual is 15, 20, maybe 30. But I think if we can do our best to make the most of these moments that we do have, and to do our best to eliminate some of those barriers that keep being put between us and the patient and our ability to make those decisions together, I think that is where the real healing comes.

We know from trauma work and trauma research that it’s that human-to-human connection that heals trauma. And the reality is, although we’re talking a little bit more about the trauma inflicted by medicine on our patients, with the training that we go through, from the time that we are premed to the time we’re practicing attendings, the system traumatizes us as well. And so if we can learn to set boundaries, to understand that self-care is not selfish, it’s self-preservation, and it also is necessary so that we can take the best care of our patients as well, then I think that’s really the thought I focus on. And I think about, OK, what adjustments do I need to make to my schedule? What do I need to push back on when administration comes asking me to double book? Or to say no, that this is what I need to practice good medicine and for me to stay healthy, because a healthy doctor also makes for healthier patients as well.

Kevin Pho: Yeah, you mentioned that trauma is sometimes inflicted by clinicians. You mention a term, clinician-associated traumatization. So tell us more about that. What does that mean?

Kara Wada: Yeah, so what you will hear patients talk about within the chronic illness and invisible illness community is this term, medical gaslighting. And that is a term, you know, gaslighting was the word of the year last year, and essentially it is describing this sense that patients will come away from a visit not feeling heard, not feeling like their story was believed, and that their concerns weren’t taken seriously for whatever reason, whether they were brushed off or perhaps those symptoms were blamed on weight, gender, anxiety, so on and so forth.

Clinician-associated traumatization is this new term that has been coined by researchers within this realm to really be a more all-encompassing term that describes what happens when patients have these adversarial interactions with the health care team that aren’t near-death experiences. We have a term that is more related to medical-related post-traumatic stress disorder, but that doesn’t necessarily explain these more insidious, kind of outpatient-type experiences that may occur more often. And so this is filling the gap, to give us language to talk about this, to study it better, and to understand it, and my hope is then to find solutions to preventing it in the first place.

Kevin Pho: Now, short of getting more time to spend with patients, because that sometimes isn’t always the case, tell us some high-yield things that we could do in the exam room to better connect with patients and get them to share their stories and be believed.

Kara Wada: Yeah, so I think first and foremost, letting the patient have that first minute or two just to share their story. It’s one of the first things we learn as we go into clinical medicine: Don’t interrupt the patient. They’ll give you the diagnosis many times if you just listen. So I think that’s one thing that has been really helpful.

Also, a mentor shared with me recently a real high-yield question that has significantly changed my practice, which is, “What are you most worried about?” And along those lines as well, “Is there anything that I should know about you in order to take better care of you?” They’re just simple, high-yield questions that may really uncover some aspects that may be really helpful.

Other simple things: I have had a few patients recently that come in with sunglasses on in our bright exam rooms because they have a headache, or maybe they suffer from migraines or are light sensitive. I can ask if I can turn the lights off. And doing simple things just to make people feel a little more loved and cared for can go a long way.

Kevin Pho: We’re talking to Kara Wada. She is an allergy, immunology, and lifestyle medicine physician. Her KevinMD article is titled “Healing clinician-associated trauma: a call for connection.” Kara, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Kara Wada: I think one of the coolest aspects that I have come across in this exploration of the idea of becoming more trauma-informed, learning how our brains work, is that we really need to celebrate that synergy that we can have between our patients and ourselves as clinicians. There truly is magic that arises from the mirror neurons in our brains when we connect, and being able to co-regulate with one another is healing in its own right.

The other aspect is we need to just remember that at our deepest, most biologic levels, we all yearn to be seen, to be heard, and to be believed. And so if we can recognize that and take that with us as we are starting off our day in a busy clinic or rounding on patients in the hospital, to just help that patient feel heard: “This is what I heard you say. I may not be able to fully explain it from the science I know, but let’s work together and partner together to figure out what the next best step forward is.”

Kevin Pho: Kara, thank you so much for sharing your time and insight. Thanks again for coming back on the show.

Kara Wada: Thanks so much for having me.