Taking the initiative to address vicarious trauma with a colleague, as in Case #2, can be challenging. If indicated, physicians can also support their patients by facilitating workplace accommodations to decrease the exposure and/or impact of vicarious trauma or in securing medical leave. As patients initiate the sometimes protracted process of connecting with mental health services, routine primary care approaches can be used to manage acute, disruptive vicarious trauma symptoms, including coaching on sleep hygiene techniques for insomnia and reviewing strategies for alleviating anxiety. 4 Engaging in therapy is critical in managing vicarious trauma, particularly given the vast effect trauma symptoms can have on mental health. The Secondary Traumatic Stress Scale can be used to elicit symptoms and as a tool to educate and facilitate discussion on vicarious trauma. Introducing the topic of vicarious trauma can facilitate patients' insight into factors driving symptoms and foster a path toward addressing underlying causes. When addressing vicarious trauma with patients, as in Case #1, it is helpful to obtain a more detailed history, including the duration and range of symptoms. 4 This scale can be used to evaluate vicarious trauma–related posttraumatic stress disorder. 4 The Secondary Traumatic Stress Scale is a validated 17-item questionnaire that was developed to measure symptoms associated with the indirect exposure to traumatic events because of one's professional relationships with traumatized individuals ( Figure 1). Symptoms of vicarious trauma are similar to those of posttraumatic stress disorder, with domains of intrusive thoughts, avoidant behaviors, and alterations in arousal. Health care–related manifestations can include excessive worrying (e.g., that a patient missed an appointment because they are hurt or have died), delays in completing the charts of patient encounters that involve upsetting stories, overreacting to unexpected environmental noises (e.g., overhead pages in the clinic, telephones ringing in examination rooms), experiencing visual images of examining an abuse-related injury in a setting outside of work, or finding it difficult to watch previously tolerable entertainment (e.g., shows or movies involving crime and violence). For example, a physician who is usually affable and empathetic may become increasingly irritable toward patients and colleagues, distant with family and friends, or overprotective in parenting. Vicarious trauma symptoms can manifest in one's professional and personal life. Unaddressed vicarious trauma can compromise a physician's ability to provide care or professional services and can affect their own personal health and relationships. See the Office for Victims of Crime toolkit 1 for a glossary of terms related to vicarious trauma ( ). Vicarious trauma can result in a change of worldview and disturb a person's sense of justness and safety of the world. Chronic exposure to secondhand trauma can lead to vicarious trauma, whereby an individual internalizes the emotional experiences of others as though that individual had personally experienced them. These clinical experiences can be compounded by other forms of witnessed trauma, including exposure to repeated violence portrayed in the news and social media. Often, family physicians are vicariously exposed to the trauma of their patients as they share stories of domestic violence, war, gun violence, child abuse, homelessness, and life-changing diagnoses, including cancer and COVID-19. Many people, including health care professionals, law enforcement professionals, journalists, and lawyers, may encounter situations that result in secondhand exposure to trauma.
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