Dear Art:
On Friday, June 11, 1982, faculty members met to discuss the performance of psychiatric residents over the past six months. Below is a summary of comments that apply to your performance.
The faculty’s reaction to your performance has been uniformly excellent. There were comments about your former fear of the role of psychotherapy, but the consensus was that this had improved markedly and that you are now more comfortable with the apparent joy of your faculty. There were comments about your diligence in reading at , with quotes such as “first-rate”, “wonderful”, and “a good teacher”.
Art, comments speak for themselves. We are pleased with your performance over the past year and consider you an excellent resident. I am delighted with this report and look forward to continuing in this direction next year.
I wish you luck.
Best regards,
[Name Withheld]
Professor and Chairman
Psychiatry
I received that letter more than 40 years ago, at the end of my second hellish stay. Unknown to anyone other than my spouse and my psychiatrist, I was recovering from the effects of “compensatory” or “secondary” trauma. defined as “devastating emotional distress resulting from an encounter with a traumatized patient or client who has sustained primary or direct trauma”.
Only in my case, at least technically, was there an intimate encounter.
In the spring of 1981, towards the end of my first year as a resident, I was asked “on call” to comment on an emergency department (ED) patient who “heard voices.” An ED resident asked my advice about his medication, but she said he didn’t have to come to the ED to evaluate him. After assuring me over the phone that her patient was not at risk, I suggested she increase her dose of haloperidol.
The patient was discharged but returned to the ED several hours later after the suicide attempt. The patient had jumped from his third floor window in the boarding house. He survived the fall, but suffered significant orthopedic injuries.
I blame myself for the incident, moral injury Violating my personal code of excellence. “I should have seen the patient,” I thought. My injuries were compounded by shame and guilt as news of what had happened quickly spread among the house staff.
PGY-II mid-term evaluation (December 1981) was so bad that he was put on probation. Clearly, I was not a rising star in the eyes of the faculty who had known me since I was a medical student. My grace after one of her faculty members (the one who actually interviewed me and encouraged me to enroll in medical school) informed me that there was no way to “sugar coat” my poor performance. Falling from has become a certainty.
Psychotherapy saved my life, allowed me to complete my residency, and even regained my star status as Chief Resident. I couldn’t overcome it. My anxiety grew with each new patient I met. What if they commit suicide? What if they are dangerous and harm someone? The idea that I am responsible for someone’s actions that could have fatal or near-fatal consequences and cause another stain on my record. I couldn’t stand it.
I published Coming Out as a form of self-therapy. paper About the incident, even though it has been 33 years since the incident. I am humbled by the many doctors who responded to the article and shared similar experiences of vicarious trauma.
One obstetrician-gynecologist wrote: When the resident assured me that I did not need to see the patient.
One colleague confided that when he was a resident and had a side job at a crisis center, he went home to assess and discharge a man who had killed his partner. The murder was covered by local newspapers and television stations. A colleague of mine was not mentioned, but he was crushed by the ordeal, suffered from intrusive memories, and suffered from sleep disturbances for months afterwards. This is a classic sign and symptom of PTSD.
There is little recognition that doctors and trauma survivors exposed to traumatic events can become traumatized themselves. 10-20% develop PTSDSurgeons and emergency physicians should High incidence of PTSD For obvious reasons. They treat a disproportionate number of trauma patients. Psychiatrists and psychotherapists are susceptible because patients discuss their disgust of traumatic experiences in detail during treatment.
A physician traumatized by an unexpected outcome such as death.surgical complications; medical errors, errors, and misfortune; and malpractice lawsuit You may develop PTSD. These doctors often see themselves as “innocent bystanders” of trauma. Nevertheless, the emotional impact can be severe and long lasting.
A doctor who wrote to me recalled being traumatized by a malpractice lawsuit and even more so when his lawyer pressured him to settle. His failure to “spend a day in court”, which he was sure would be proven, contributed greatly to his PTSD and “emotional inability to stay in practice.”
After exposure to trauma, it may be impossible for doctors to function normally again.of coronavirus pandemic Approximately 20% of physicians are the reason for leaving practice within two years. Many physicians feel pushed to their limits and traumatized by a variety of practice-related stressors. The threat of violence looms largesusceptibility to both indirect (surrogate) and direct (physical) trauma.
Medical students often feel that they are experiencing symptoms of the disease they are studying, but students are at real risk of suffering from PTSD when they enter an internship. My practice date was less than ten years after my residency. I searched the industry for low-stress jobs—pharma and health insurance—and never looked back.
Yet every spring it evokes an anniversary response. I think of “jumper” and think “what if?”
Arthur Lazarus It is a psychiatrist.
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