How Physicians Manage Bearing Witness to Trauma

Medical professionals need the tools to deal with vicarious trauma.

Note: Patient and family details have been modified to protect confidentiality.

When I walked into the room, she and her father were looking through old photos together. He was more present that day, despite the scabs and small areas of dried blood on his face, and the bruises still peeking out from beneath his hospital gown. She was doing her best to hold it together.

He had stage 4 cancer and had been on the verge of hospice when a traumatic fall brought him to us. He was stubborn, still fighting to hold onto his independence. It was the kind of stubbornness I recognized in my own father at an earlier time in our lives.

Now the conversation we’d been circling had to happen.

He was being transferred back to his in-network hospital, now more stable, with goals of care clearly defined: Hospice. She looked at me with tired eyes and asked me what I would do if it were my father.

I told her.

She was reassured and said, “I don’t know how you do it, doc.”

It was that kind of week. 

In medicine, we sometimes joke about themed weeks. Some weeks we see multiple patients with heart attacks or strokes. This particular week had a theme none of us chose: hospice. Multiple patients transitioned to comfort care within a week. Multiple families navigating the hardest conversations of their lives. Multiple moments of sitting at the bedside, bearing witness to grief in real time. 

For whatever reason, this patient stuck with me. Maybe it was the state he arrived in, or the loyalty he commanded of his friends and loved ones despite his personal struggles with substance use. Or maybe it was because I had been in that daughter’s position not too long ago. When the conversation turned to hospice, I understood the weight of trying to make the right call for someone who raised you and loved you so deeply.

She wasn’t the only one who said those words to me that week: “I don’t know how you do it.”

Multiple families. Same phrase. Same week.

Which made me wonder: How do we do it?

The Toll Vicarious Trauma Takes on Physicians

Vicarious trauma is the cumulative emotional impact of repeated exposure to patients’ suffering and loss. Over time, that exposure disrupts our deeply held beliefs about safety, trust, and justice in the world. It seeps into how we parent, relate to our partners, and move through everyday life. If left unaddressed, research suggests it can progress to PTSD. In 2013, the DSM-5 added “repeated or extreme indirect exposure to aversive details of a traumatic event," such as that experienced by a first responders or police, as a qualifying stressor for diagnosis. This is not a coincidence, and is recognition that what we witness at work carries real psychological weight.

Over time, the weight accumulates. Vicarious trauma can manifest as what trauma-informed clinicians recognize as the four trauma responses: fight, which can look like irritability or outbursts with colleagues or at a meeting; flight, which can look like avoiding difficult conversations or calling in sick at the last minute; freeze, which can look like emotional numbing; and fawn, which can look like over-accommodating others at the expense of our own boundaries. If left unaddressed, research suggests these responses can deepen and progress to PTSD.

What I find interesting is that none of this was ever part of our medical training. Physicians were taught to diagnose and treat. We were taught to compartmentalize, which lets us walk into the next room and be present for our next patient. But compartmentalizing without ever processing is where it starts to cost us.

Small, Intentional Practices Help Us Manage Vicarious Trauma

This isn't just a physician problem. Anyone who does emotionally demanding work, like social workers, caregivers, and first responders, knows this weight. The good news is that small, intentional practices can make a difference. These are practices anyone can use, regardless of what field they're in.

Simply naming that “it’s been a really hard week” is more powerful than it sounds. From there, creating a transition ritual can help process the feelings we carry between work and home. For some it’s as simple as taking off work clothes at the end of the day or showering when they get home. Journaling—getting the experience out of your head and onto paper—is an option. A few minutes of intentional breathing or mindfulness can be another. Getting support by talking to a colleague or someone you trust is also part of it, as is seeking your own dedicated space through therapy or coaching.

At the same time, this shouldn't fall solely on individuals to figure out alone. Organizations have a role in recognizing the weight of emotionally demanding work, intentionally creating space and time for processing, and building cultures that genuinely care for its people.

Since that week, I’ve thought a lot about the phrase, “I don’t know how you do it”. 

The honest answer, the one I didn’t say, is that sometimes I don’t. Sometimes it follows me home and seeps through when I’m spending time with my family. Sometimes a patient reminds me of my father, and I just have to sit with the feelings of grief that come with that.

Here’s what I’ve come to understand: In most rooms, it isn’t my medical knowledge that matters most. It’s my presence and willingness to sit with a family in the uncertainty and offer reassurance even though sometimes there’s no “right” thing to do in medicine. Not every case is a complex diagnostic mystery waiting to be solved, like something out of a House episode. Some of the hardest cases aren’t mysteries at all. They’re just life, unfolding in front of us whether we’re ready or not.

What our patients deserve is the willingness to stand beside them in those moments. To guide them with our knowledge, and hold space for what can’t be fixed, diagnosed or charted. To bear witness, fully, humanly, to what is unfolding in front of us. And then, when we walk out of the room, to take seriously the weight we are carrying. To name it and process it. Because unprocessed vicarious trauma accumulates and changes who we are as doctors. If we are not intentional about tending to it, it will erode the presence and compassion that make remarkable physicians in the first place.

That is the work we do as physicians. It’s not easy, but I absolutely love what I do. And I’d choose to do this over and over again.

A version of this was published at Psychology Today: https://www.psychologytoday.com/us/blog/the-other-side-of-the-white-coat/202606/how-physicians-manage-bearing-witness-to-trauma 

References