Understanding PTSD in Medicine: Recognizing, Managing, and Supporting

By Jordan C Kabins, Ph.D., MBA

Introduction

The medical profession, with its inherent demands, requires practitioners to navigate high-stress situations, emotional trauma, and life-or-death decisions on a daily basis. Despite these challenges, healthcare professionals demonstrate remarkable resilience and professionalism, showcasing their strength and dedication. However, it is essential to acknowledge that these challenges can lead to significant psychological impacts, including post-traumatic stress disorder (PTSD), a condition historically associated with combat veterans and victims, which is now increasingly recognized as a critical issue within healthcare.

The Reality of PTSD in Medicine

PTSD arises from exposure to traumatic events that overwhelm an individual's ability to cope. In medicine, such events are unfortunately common: losing a patient despite best efforts, witnessing catastrophic injuries, or being involved in ethically complex scenarios, such as resource allocation during a pandemic. For instance, a surgeon who loses a patient on the operating table after a long and challenging surgery, or a nurse who witnesses a severe car accident victim succumb to their injuries despite their best efforts, may experience symptoms of PTSD. Research indicates that healthcare workers, particularly those on the frontlines, are at a heightened risk for PTSD. A study conducted during the COVID-19 pandemic revealed that approximately 14% of U.S.-based healthcare workers screened positive for PTSD, a prevalence significantly higher than that of the general population (Bayazit et al., 2022; Prasad et al., 2021).

Risk factors for PTSD in medical professionals include prolonged exposure to high-stress environments, lack of support, and moral injury—the psychological distress resulting from actions that violate one's ethical or moral code. Healthcare workers often encounter situations where they feel powerless, such as being unable to save a patient due to resource constraints (Schein et al., 2021). This feeling of powerlessness, especially when it stems from a situation that contradicts one's moral or ethical beliefs, can lead to moral injury and increase the risk of developing PTSD (Benham et al., 2022).

Signs and Symptoms to Watch For

Recognizing PTSD in oneself or colleagues is the first step toward addressing its impact. Symptoms of PTSD in medical professionals can manifest as: 

- Re-experiencing: Flashbacks, intrusive thoughts, or nightmares about traumatic events.

- Avoidance: Steering clear of trauma reminders, including people, places, or activities.

- Hyperarousal: Heightened irritability, difficulty sleeping, or being easily startled.

- Negative Mood: Persistent feelings of guilt, shame, or detachment from others

Healthcare professionals may also experience secondary effects such as burnout, substance use, and decreased quality of patient care (Bender et al., 2021).

Cultivating a Culture of Support

Creating a culture where seeking help is normalized is vital. Stigma remains a significant barrier to treatment; many healthcare workers fear that admitting to mental health struggles may impact their career progression. Educational campaigns, testimonials from respected peers, and visible organizational commitment to mental health can help dismantle these barriers (Smallwood & Willis, 2021). 97 95 96

As the medical community grapples with the demands of the profession, prioritizing mental health must become as fundamental as clinical care. Recognizing PTSD as a genuine and pressing issue allows for proactive measures that not only protect healthcare workers but also enhance the overall quality of care provided to patients.

Citations

Bayazit, H., Ozel, M., Arac, S., Dulgeroglu-Bayazit, D., & Joshi, A. (2022). Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic. Journal of psychiatric practice, 28(5), 354–361. https://doi.org/10.1097/PRA.0000000000000661

Bender, A. E., Berg, K. A., Miller, E. K., Evans, K. E., & Holmes, M. R. (2021). “Making sure we are all okay”: Healthcare workers’ strategies for emotional connectedness during the COVID-19 pandemic. Clinical Social Work Journal, 1-11.

Benham, T. L., Hart, A., Bortolin, M., Groves, J., Kraus, A., Newbury, B., ... & Ciottone, G. R. (2022). Preparing for the second surge: preventing posttraumatic stress disorder and building resilience for health care workers in the face of COVID-19. Disaster medicine and public health preparedness, 16(2), 714-717.

Prasad, K., McLoughlin, C., Stillman, M., Poplau, S., Goelz, E., Taylor, S., ... & Sinsky, C. A. (2021). Prevalence and correlates of stress and burnout among US healthcare workers during the COVID-19 pandemic: a national cross-sectional survey study. EClinicalMedicine, 35.

Schein, J., Houle, C., Urganus, A., Cloutier, M., Patterson-Lomba, O., Wang, Y., ... & Davis, L. L. (2021). Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. Current medical research and opinion, 37(12), 2151-2161

Smallwood, N., & Willis, K. (2021). Mental health among healthcare workers during the COVID‐19 pandemic. Respirology (Carlton, Vic.), 26(11), 1016.