PostScript

Traumatic Disconnection
by Nick Gavin


As a new clinical medical student interested in social determinants of health, it’s usually easy for me to understand my patients’ feelings and identify with how they are responding to particular situations. However, at times there is a lapse in empathizing, and I can’t help but wonder how patient care is being affected. This disconnect between me and my patient was never more apparent than on my trauma rotation. Each time I walked into the resuscitation unit, a similar scene was laid out before me: young, male, low socioeconomic status, wrong place, wrong time. While this was somewhat expected (particularly in penetrating trauma cases), what I did not expect was the fatalistic mentality of some of the patients. A common refrain sounded like:

“This is just a fact of life when you’re on the street.”

Each time, I couldn’t help but compare my patients’ situations to my own—after all, most were my age. The facts of my life include working, studying, eating out, going out with friends. Being shot would be traumatic. Watching my patients’ casual behavior, I couldn’t help but wonder if some of these injuries had the same effect on them. Maybe the scene was too familiar, or too common where they come from. It seemed as if the trauma had been blunted in some way by the expectation of one day being shot or stabbed.

This is what I could not understand. I simply could not relate to this brand of fatalism, the kind tinged with pessimistic resignation. Bridging the gap required me to think about being raised with the expectation of eventual or continuous trauma. Imagining just how many kids are raised in this state was frightening. It also made me realize that primary prevention of penetrating traumas had almost entirely to do with preventing this state of mind in the first place. My question now is: how should emergency physicians step into this preventive role? And how will my generation of EM physicians “treat” these patients differently, if at all?

Implications

In medical education, there is an intense push to impart the value of empathy and understanding on medical students. For most students, there is little struggle in “feeling for” patients but often it can be difficult to communicate this true concern — patients often come to the encounter with biases and assumptions about their caretakers which make it difficult for students to seem authentic. Sometimes, though, the biases and experiences of the provider, or in my case the student, sneak into the patient-physician relationship and interfere with the understanding of the patient’s situation, creating a gap between the patient’s reality and the provider’s spectrum of comprehension.

Empathic relationships with patients are essential for trust of medical institutions generally and rapport with each of us as physicians. Sometimes the path to empathy is not natural, and requires a little thinking. Maybe the seed of policy solutions lies in that thinking.

Nick Gavin is a third year medical student at NYU School of Medicine who is interested in emergency medicine and the sociology of health care.