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Forgotten Victims of PTSD: How surgeons are at risk for stress disorder symptoms
This summer, The New York Times shed light on a dark topic – that of post-traumatic stress
disorder (PTSD) that originates in the Intensive Care Unit. In the July 2013 piece,
“Nightmares after the ICU,”the reporter sharedhorrifying stories of patients whodeveloped
PTSD after receiving treatment in the ICU.
But while the story focused national attention on PTSD in patients (and even caregivers), it
included nothing about PTSD symptomsinthe physiciansthemselves. In fact, little has been
written, spoken or researched about the possibility of psychological stress disorder from a
physician’s perspective (and even more specifically, a surgeon’s). However, one Baylor
University Medical Center at Dallas researcher has set out to change that.
Researching the risk of physician trauma
Dr. Ann Marie Warren, from Baylor’s Division of Trauma, became intrigued about the
potential risks that surgeons face when they’re exposed to trauma patients daily. After she
joined Baylor two and a half years ago, she was asked to steer a research-focused program
specific to trauma.
Her efforts were originally designed to look at patients and families, but through the course
of her work she found consistent evidence that patients aren’t the only ones affected by
these experiences. Physiciansare at risk, too.
“As a clinical psychologist, much of my interest and expertise is on the psychological
aspects of trauma,” Dr. Warren said. “In working with my colleague Dr. Michael Foreman,
our trauma medical director, we both felt that the psychological impact on clinicians would
be both novel and interesting to examine.”
Drs. Warren and Foreman began directing their attention to the study of secondary
traumatic stress (STS), a disorder that is very similar to PTSD but occurs in individuals who
have experienced trauma through a secondary source – quite simply, when a surgeon works
with a patient who has sustained direct trauma.
Those efforts were channeled through the initial research project, introduced in the July
2012 edition of BaylorHealth, which aimed to answer this critical question: Does caring for
trauma patients lead to psychological stress in surgeons?
The answer was a very sobering “yes,” but with a caveat. Indeed, the prevalence of STS
symptoms in surgeons presents a very profound risk. Based on a survey of respondents, Dr.
Warren found that 22 percent met the criteria for PTSD, and almost two in three surgeons
represented at least one STS symptom. Among them:
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Intrusive thoughts about patients (53.3 percent)
Irritability (50.4 percent)
Emotional numbing (35 percent)
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Reliving a patient’s trauma (9 percent)
Avoidance of people, places and things (8 percent)
Disturbing dreams (7 percent)
But the caveat lies in the fact that not all surgeons face equal risk for STS. Dr. Warren’s
team found that practitioners have varying degrees of “resilience,” or vulnerability to stress
disorder symptoms when faced with cases of severe trauma. Significant data showed that
patients with higher resilience had lower risk of STS, and vice versa.
Surprising to the researchers:The amount of time spent with trauma patients had little or no
effect on the surgeons’ development of STS symptoms. Rather, the resilience of a surgeon
plays a more important role in stress disorder risk.
Data collection through respondent surveys
Dr. Warren curated her data through the use of a demographic questionnaire she distributed
at two regional surgical conferences. An overwhelming majority agreed to participate, she
said.
The questionnaire asked respondents’ basic demographic information – including sex, age,
ethnicity, education, years of experience and percentage of time working with trauma
patients.
It also asked surgeon respondents to rate how frequently trauma in their environment can
impact their work and to assess their own resilience to trauma. She collected completed
questionnaires from 133 surgeons (111 men and 22 women).
The need for PTSD awareness for surgeons
With nearly two in every three surgeons displaying some traumatic symptom, Dr. Warren
wrote, the study’s results reveal the need to recognize trauma risk in surgical education and
continuing medical education.
Since the research strongly suggests that surgeon resilience is an important factor to
combat the risk of PTSD symptoms, it also could be worth noting that those considering a
career in surgery should consider a self-assessment of their own resilience.
“My hope with this research is that surgeons can be more aware of this phenomenon,” Dr.
Warren said. “Ideally, I hope that further research would help identify surgeons at risk and
provide interventions, because the mental health and well-being of surgeons obviously has
an impact on their patients.”
Given these foundational results, Dr. Warren and her team expect to continue their work
related to the topic of STS in surgeons, with a particular focus on the concept of resilience.
The study originally appeared in the July 2013 edition of the Journal of Trauma and Acute
Care Surgery. Read the abstract here.