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Commentary on ' Lessons Medical School Is Missing'

 , March 04, 2016

Life’s traumas come in many forms, and not all of them are as dramatic as the scene faced by our medical student protagonist in this essay. As a resident in pediatrics, I think about trauma on a daily basis. We know that the vast majority of experience that impacts a person’s health happens outside the walls of the hospital or clinic. Our patients come to us with traumas both insidious and glaring (think sexual assault, poverty, neighborhood violence, overseas warfare, historical trauma, and bullying), and there is only so much we can do. While we do have the potential to impact the circumstances of our patients’ lives through advocacy around social determinants of health, we cannot protect our patients from everything.

Losing a patient can be a trauma in and of itself. When medicine fails, when there is no happy ending or we do not save a life, we have to be able to take a deep breath, stand up, and help the next person. The ability to do this gracefully and sustainably requires years of practice, but I agree with the authors’ suggestion that it start early. We need to teach medical students how to mourn our patients and then take care of ourselves so that we can keep taking care of others. In light of recent attention to physician suicides and other mental health issues, it is imperative that we learn how to address these “existential impasses.” While we learn how to handle traumas in emergency departments, we don’t often learn how to handle the traumas we ourselves will face on a regular basis.

Mulcahy and Nash challenge us to envision medical education that equips us to identify and deal with our own traumas as much as we deal with others’. Some medical schools are already employing wellness programs, but there is much more that can be done. Let’s use the same high-level thinking that has shaped our understanding of trauma in our patients and apply it to ourselves. The future of medicine depends on it.

Irène Mathieu