How can GPs look after themselves in the wake of so much trauma?

Imaan Joshi

21/03/2019 3:07:52 PM

Dr Imaan Joshi reflects on what has worked for her in dealing with last week’s traumatic events.

Candlelight vigil
‘Amidst vigils and offers of support from trained people, I know the aftermath of this attack may well come up in the consultation room,’ Dr Joshi wrote. (Image: Vincent Thian)

We have to look after ourselves first, so we can continue to look after our patients.
The reason, of course, is that it has been a hard couple of weeks for everyone.
For people like myself, with a history of trauma, following the news has risked triggering new trauma.
On Wednesday 13 March, we heard the news that Cardinal George Pell was sentenced to six years behind bars, with parole possible in fewer than four years, after he committed sex offences against two teenage boys in the 1990s.
Following the news, while in a group of doctors who are current and past survivors of trauma, I listened to fellow colleagues express their outrage and despair at the sentencing.
Then came Friday 15 March. I had just finished a long consultation with a patient who had been sexually abused by a church member in power when the news started coming in.
On the train home from work, I read more and more about the terrorist attack in Christchurch, in which 50 Muslim worshippers were murdered as they gathered for the weekly Friday prayers at two mosques.
Media outlets had not spared the gory details of the events, down to the cries and devastation of the victims. While I avoided the 17-minute livestream that was making the rounds, I did read the horrific sequence of events – right down to the gunman’s words before he began his rampage.
Sleep was hard to come by that night, for me and many of my Muslim friends and colleagues.
A man I’d communicated with briefly in the US texted me, to ask if we were okay, but also to warn us to stay on guard. Other non-Muslim friends reached out to offer support.
I kept thinking of the man who ran outside the mosque to find his wife and children slain.
Fifty people had been murdered in cold blood.
The brief monologue from The Project’s Waleed Aly that night finally allowed my tears to flow.
I spent last weekend in contemplation of an event that was so close to home, and which could have occurred here just as easily.
Amidst vigils and offers of support from trained people, I know the aftermath of this attack may well come up in the consultation room.
Many of our patients are Muslims, and many are people who suffered psychologically each time a terrorist has attacked non-Muslims elsewhere in the world. I know this because there are often conversations in medical forums around the safety of Muslim colleagues, and whether we experience racism from our non-Muslim patients.
I and other Muslim GPs are in the unique position of being part of a community of victims who also work to support others who have suffered or are suffering, either due to being Muslim, through having known someone who was killed, or through vicarious trauma.
With one in four Australians experiencing anxiety, and the number of GPs who treat mental health presentations steadily rising, it is to be expected that we will see people who have been affected by both the Pell and Christchurch events, as well as the ongoing dialogue on social media.
So how do we support our patients if we are affected ourselves?
While no expert, I have some suggestions for GPs. We have to focus on ourselves first, in order to be able to help our patients. These are the things that have worked for me:

  • Focus more on caring for yourself and your family. Switch off the TV, ignore social media and take a break from the constant loop of news.
  • If you have children, try to prepare them for the news and what they will likely hear from their peers at school. If we prepare them and explain matters in an age-appropriate way, they are less likely to be shocked or affected.
  • Do not watch the livestream of the Christchurch massacre. Refuse to watch it if anyone has saved a copy. I taught my own children years ago not to mindlessly look at anything their peers wanted them to see on phone screens. While that was regarding pornography, it equally applies to violence.
  • Try and get out if you can. Go for a walk, listen to music, exercise. Do something that takes you away from media and technology and out into using your physical body. It can be a form of grounding.
  • For those of us with a history of trauma, DO NOT try closing your eyes and meditating, as it can cause flashbacks. Instead, I would encourage simpler measures to ground yourself. I often encourage people to sit with a cup of tea and focus on drinking that mindfully, noting each sip, the mouthfeel and heat. At the worst moments of my PTSD, I used to find washing dishes in the sink to be my saviour – the feel of the warm soapy water, the suds against my skin and the repetitive motion of the sponge against dirty crockery all acted to soothe me.
  • Get enough sleep. This is a great time to talk about sleep hygiene, and to implement it, including the no TV and no technology in bed rule. Eat well and don’t skip meals.
  • If it all feels too hard, reach out to others – even if only to sit with them and talk about nothing.
There is no panacea and no silver bullet to deal with these traumatic events.
But I have found these measures can make the difference between being caught in a well of despair and being able to put one foot in front of the other until the overwhelming feelings begins to recede.
These techniques work just as well for patients as for GPs.
For patients affected by trauma, a GP’s role can be supporting them through non-judgemental listening, even if we don’t understand the fear or their culture. We can practice active listening and sit and hold space for them while they grieve. We can offer ongoing help such as recommending a trauma-informed psychologist.
And if we ourselves are trained in dealing with trauma, we can offer our own services. That is what I will be doing with my patient dealing with religious sexual abuse, who was shaken by the Pell ruling and who didn’t want to revisit the topic with ‘yet another person who won’t get it.’
There is so much we can do. It can become easy to forget that. But it is vital we use our own oxygen mask first so we can help others.

coping strategies current events mental health terrorism trauma traumatic events

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Ramanpreet Kaur   22/03/2019 7:04:57 AM

Thank you do much Dr Joshi for putting it so well. Yesterday I saw my worst case of domestic violence and couldn't sleep all night. I am traumatised and can't take it out of my mind. Your article was so powerful and healing. Thank you.

Elizabeth Hindmarsh   22/03/2019 7:37:52 AM

An excellent reminder of stopping to deal with our own trauma as we seek to help our patients. Thank you for sharing. There is a mantra ‘I cannot give to others out of an emptiness in myself’

Jessica Richards   23/03/2019 10:55:07 PM

Thanks Dr Joshi. How simple and gentle and reflective. Great advice. We all salute and support you

Dr Frederique Bentley   24/03/2019 8:07:49 PM

Thankyou for the advice.Your presence must bring comfort to many.
How to find one's own inner resources and protection and
also "hold a space "for our patients' grief or despair in a world that is,at times, cruel and senseless.

Sangeetha Ponnusamy   25/03/2019 11:43:01 AM

Thank you so much Dr Joshi. You have conveyed the most crucial thoughts in very simple words. We need that enormous mental resilience to support and help people. That would come only by taking care of ourselves first.

Shaza   28/03/2019 2:01:11 AM

Thanks Dr Joshi .Your use of words are incredible!These were exactly my feelings on my day return to work after the horrific weekend (Muslim myself ) .Being Dr we often forget our own health .Putting feelings into words is another way of counselling .