Easing the trauma of medical procedures

October 30, 2018

While we strive to heal patients and rid them of their diseases, those very efforts can be very traumatizing to patients. As doctors, we should take steps to minimize their ordeal.

Editor’s Note: Physicians Practice’s blog features contributions from members of the medical community. These blogs are an opportunity for professionals to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions are that of the writers and do not necessarily reflect the opinions of Physicians Practice or UBM.

Many medical procedures can be quite painful, and beyond the physical pain, studies suggest that posttraumatic stress disorder (PTSD) is quite common after a range of medical procedures and in patients with certain medical diagnoses. Bone marrow biopsies have been reported by patients to be traumatic experiences, anywhere from 18.5 to 59 percent of patients who were admitted to the intensive care unit (ICU) developed PTSD symptoms in the years following their hospitalizations, and PTSD was found in 16 percent of patients suffering a myocardial infarction. 

How can we, as healthcare experts, reduce the trauma associated with medical care? 

Prepare them. Hospitals can be scary places. Patients are often not allowed to even get out of bed without assistance, and medical staff from different levels of training are entering their rooms in a seemingly constant stream to check their vital signs, draw their blood, take them for x-rays, bring their food, etc. How many of them stop and explain what they are doing and why they are doing it?

In a recent white paper from PlatformQ Health, approximately 50 percent of patients reported that additional education is needed for newly diagnosed patients. Even if a procedure is still quite painful, if they know what to expect it will be easier to bear. If something is going to be painful, tell them that. If you can, tell them how painful it is going to be. Is it going to sting like a bee or feel just like a pinch? Or worse?

Ask if they have any questions before you start. And answer them. Only start when the patient has no more questions. No patient wants to be managing a health problem, so giving them a chance to go over their questions with you beforehand can help them feel empowered in a tough situation.

Don’t rush. We all have busy schedules, but realistically we can only treat patients one at a time. When patients feel you are rushing, their fear is heightened making it a worse experience for them. Likewise, it is easy for patients to attribute their pain to your “rushing” rather than understanding that some procedures just are objectively painful, even when performed perfectly. Do yourself a favor and take the time you need to make your patient as comfortable as possible. 

Explain what you are doing. Talk out loud, step-by-step, and explain what you are doing and why. Not only will it ease the patients’ fears to hear you going through the steps that you have prepared them for, it will help the procedure pass faster in their minds if they aren’t just enduring through a wall of silence. 

If they are in too much pain, stop. We know it’s how much it’s going to hurt. Even if we try to explain it ahead of time, the patients do not. They may need just a breather, so give them a rest if they need it. Having no control in a painful situation makes it even more frightening, and you can help them feel they have some control by letting them decide whether the procedure continues or not. 

Admit any complications. If the patient bled more than expected and is likely to have a big bruise after they go home, tell them. If they go home and see or feel something they weren’t prepared for they may worry about something more dire-and they could even blame you for doing something wrong.

Give them crystal clear after-care instructions. Patients need to know what to expect afterwards and have a course of action. Will it still hurt when they go home? Are they restricted from doing a certain activity? How long until they have a follow-up appointment? What are the specific symptoms they should watch out for that would indicate a real problem? Help the patient and their caregivers promote the best outcomes by spelling out all the details-preferably both in conversation and in a written form, so they can check back if they forget. 

While we strive to heal patients and rid them of their diseases, those very efforts can be very traumatizing to patients. As doctors, we should take steps to minimize their ordeal.