I hope this well-being message finds you doing and feeling well. June is Post Traumatic Stress Disorder (PTSD) Awareness Month. PTSD likely has existed since the dawn of time, but it was only officially recognized as a diagnosable condition in 1980 when published in the Diagnostic and Statistical Manual (DSM). PTSD is a condition in which someone has experienced or witnessed a situation that was deemed frightening, dangerous, life threatening to self or others, and/or even the potential/perception of all of the above. Another newer added symptom to the DSM-5 diagnosis criteria is “experiencing repeated or extreme exposure to aversive details of a traumatic event.“ The primary symptoms of PTSD are flashbacks, nightmares, episodes of severe anxiety, psychophysiological and somatic symptoms (i.e., shortness of breath, muscle tension, sweats), panic attacks, uncontrollable thoughts about the traumatic event, and overwhelming fear of reoccurrence. Symptoms may start within a month of a traumatic event or sometimes years after the event and are generally grouped into four primary categories: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions.
From a diagnostic perspective, PTSD has historically and clinically been deemed most appropriate for war veterans, victims of natural disasters, and those involved and exposed to violence. While we greatly respect such individuals, PTSD can happen to anyone and there’s a greater potential for PTSD in situations where life and death are addressed. Thus, it is important to highlight the added risk for healthcare workers and especially those in direct patient care/assist, such as physicians, APP's, nurses, and select others. In addition, empirical evidence suggests that 40% of healthcare workers have experienced PTSD as a result of the pandemic (Source: NIH). It’s time to talk about trauma in healthcare.
While trauma likely dates back to the beginning of time, so does trauma in one of the oldest professions: medicine. Physicians and other healthcare workers are exposed to potential and actual trauma regularly. Trauma in healthcare settings includes, but is not limited to, witnessing death (especially unusual cases), feeling responsible for a poor medical or surgical outcome, repeated/lengthy exposure to a code blue, seeing excessive amounts of blood or other medical trauma, and even excessive disruptive behavior from patients. I never doubt the strength and resilience of physicians and other healthcare workers, but we need to be offering much more support to people exposed to trauma and perceived traumatic situations. So, what should we do??
My theory is that we need to create a culture that values training and debriefing very difficult events or situations so the consequential emotions do not build overtime. We need to have systems in place to reach out to individuals after they’ve been exposed to potential trauma to see how they’re doing and coping. In my opinion, outreach should occur soon after the event, one week later, and one month later, in the most respectful form of communication possible. If we make this a standard protocol people won’t feel selected after a traumatic incident. Another reason this is important is because healthcare workers are very susceptible to Acute Stress Disorder. This is also a response to trauma with a similar symptom profile to PTSD, but usually dissipates within days or a couple weeks. When trauma does not dissolve over this time, it has the potential to turn into a chronic form of PTSD, which can have long lasting physical and psychological impact. We should collaboratively work to address and talk about PTSD to prevent PTSD.
I wish I had more time and space to write about this topic, but I and other well-being professionals in your regions have time and space in our offices to talk and debrief about this topic. Please consider reaching out after you’ve been exposed to something potentially traumatic in your work or personal life or if you’re experiencing residual symptoms and characteristics of PTSD from the pandemic or prior. If we need to initiate treatment (and there are good ones for PTSD) the sooner that is started the better. I care about you and your well-being. Until next time. Be well and whole.
Ravi Sabapathy, PsyD
Medical Staff and Team Member Well-Being Director
AdventHealth Shawnee Mission
Sources:
Andhavarapu, S., Yardi, I., Bzhilyanskaya, V., Lurie, T., Bhinder, M., Patel, P., Pourmand, A., & Tran, Q. K. (2022). Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry research, 317, 114890. https://doi.org/10.1016/j.psychres.2022.114890
