When care hurts 

By Marlise Jeanne Pierre-Wright, MD, MPA, Northwestern University  

My patient—Ms. C—badly needed dialysis. Her calcium was much lower than I’d ever seen in a patient, and I was afraid she’d have a cardiac arrest if it wasn’t corrected soon. Although I expressed my concern, Ms. C was still hesitant. I felt a sense of urgency as our transportation waited impatiently to take her down to the dialysis suite. Eventually, they left. I wish I’d had time to learn more about why she didn’t want to go to dialysis, but my team and I had to go round on our other 14 patients. 

Trauma-informed care 

In my work to learn more about how to provide trauma-informed care—care that acknowledges the impact of difficult times, including childhood adversity, on one’s health and wellbeing—I’ve learned from patients that being in the hospital can be a source of trauma in and of itself. And this can exacerbate any trauma patients have experienced in the past, especially prior hospitalizations.  

For example, a patient, Ms. L, described how her past experiences as a pediatric patient continued to impact her as an adult patient, “When I had my neck abscess . . . I know I mentioned to [my healthcare team] that I was very nervous about having my neck abscess drained at bedside because when I was a little kid, I had an abscess on an ear that was drained in the doctor’s office, where they held me down . . . while I cried and screamed.” Ms. L expressed frustration that her medical team didn’t inquire about past experiences, leaving her need for a non-retraumatizing procedure unaddressed. 

Medical trauma 

Medical trauma refers to the specific and painful experiences patients may have that are caused by the healthcare system. As healthcare professionals, of course it’s not our intention to traumatize or retraumatize patients in the process of healing, but sometimes without realizing it, we do.  

Through my research project, “Building Trust Through Trauma-Informed Care,” it became clear to me that as clinicians, we need to think more about how our diagnostic process—all our poking and prodding and procedures—can impact patients psychologically, and potentially create distrust, fear, and anxiety during future encounters with the healthcare system.  

Here are a few things from my research that can improve our care of patients: 

1. Upon admission, ask patients, “What can we do to keep you safe and comfortable during this hospitalization?” or “Is there anything we need to know about your past experiences with healthcare so that we can best care for you?”  

2. Explain to patients why each test or procedure is being done. And most especially, always describe invasive procedures and work to gain consensus with patients if they’re anxious or have any hesitations to treatment plans.  

3. If a test or procedure is too much, work with patients to find an alternative plan, and help them to feel empowered in their healthcare decision-making (one of the six guiding principles of trauma-informed care). 

Time is always an issue and a barrier to providing this level of care. After rounding on patients, fielding pages, and finishing up my sign-outs, I finally made it back to Ms. C’s room. After taking some time to talk with her, I learned her family member had had a bad experience with dialysis, and she didn’t want to end up in the same position. She expressed her concerns, and I expressed mine. I explained dialysis to her. She explained her fears of being alone in the suite with no one to reach out to if it was all too much. In the end, we settled on her going for a short session with her family available on FaceTime to support her. The next day, her labs looked better. When I asked her how it went, she smiled and said, “It was fine.”  

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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.