“Shock, confusion, and disbelief” is how Dr Michael, a young medical trainee doctor, describes losing his first patient.
The loss left the 24-year-old fourth-year student in a local medical school, speechless, helpless, feeling guilt and not knowing how to break the bad news to the mother of the baby.
Like Dr Michael, losing patients without essential coping mechanisms puts many medics at risk of vicarious traumatization-which is the emotional and psychological distress medical workers experience after repeatedly witnessing the trauma, suffering or death of their patients after tireless attempts to save them.
Besides lack of control, another medic, Dr Imani says she feels guilty especially if a patient dies of a non-life threatening chronic illness like diabetes. Coping gets more difficult considering the ‘buck’ stops with them and it’s even worse if the doctor had formed a connection with a patient, says the 29-year-old.
Others question their professional capability, experience self-loathing, intrusive imagery, low self-esteem, and question one’s right to be alive or even happy. If left unchecked, these adverse changes could be a trigger for other mental health-related issues like increased stress levels, anxiety, and depression.
Other traumatising cases include repeatedly hearing or treating cases of sexual assault. Dr Frédéric Dutheil and other medical researchers studied medics during the Covid-19 pandemic and in their findings in 2019 note that medical workers, particularly women, are at risk of suicide due to working in situations that expose them to life and death emergencies, long and unpredictable shifts and easy access to means of committing suicide, compared to the general population.
Women medics also report higher suicide rates than men due to their social family role or a poor status integration within the profession. Preventative measures are thus in order.
Though a lot of focus on vicarious trauma among healthcare workers has been placed on mental health professionals like psychologists especially trauma therapists who provide psychological services to survivors of trauma. Sadly, the medical work is often neglected with little attention paid to doctors and nursing staff on how they are impacted by patients’ trauma or death. Dr Michael, for instance, confessed he could have coped better had he been adequately briefed during training on his expectations when treating a patient. He now reckons the unfortunate loss of a patient opened him up to the gap between medical training and real-life experiences while at work.
Indeed Dr Dutheil notes that perfectionism, compulsive attention to detail, an exaggerated sense of duty and an excessive sense of responsibility and a desire to please everyone, are risk factors for suicide among medics. Different medics cope differently after losing a patient: Dr Imani says spirituality helps as she works in a mission hospital which has a chaplain who provides spiritual support. She reckons having mental health professionals for debriefing, group therapy and peer support would help many frontline health workers.
Furthermore, vicarious trauma among medics poses ethical risks because of the increased potential for medical errors, increased feelings of guilt and increased risk of compromising ethical boundaries; especially explaining loss to the affected family.
Vicarious trauma also affects health facilities as negative effects included heightened stress levels, absenteeism, reduced team cohesiveness, morale and reduced resilience and making them prone to future destabilization, according to Dr Samantha Hartley and fellow researchers in the UK who studied the mental health of nurses in relation to their patients and published their findings in 2019.
A destabilised medical worker especially in a surgical procedure poses the risk of a medical error, thereby impacting the patient’s outcome.
Irene Tarigo and Josephine Ndanu, PhD are Clinical Psychologists in Nairobi.
Doctors;Nurses;Ministry of Health