Making Promises to Patients | Patient Centered Care and Trauma Informed Care for Pediatric Patients

Pediatric Medical Traumatic Stress

Of the tenets which make up the practice of trauma informed care, the first and foremost is to minimize traumatic aspects of medical care. That is to pay attention to the child's and family's experience of medical care and do what you can to reduce frightening or painful aspects of necessary care and procedures. Seem simple enough, right? For the most part, providing patient's and family's with easy to understand information, anticipatory guidance and compassion will help relieve many of the fears surrounding medical care.

Doctor Provides Trauma Informed Care

If the patient requires care due to a serious injury or illness, minimizing the traumatic aspects of care becomes more nuanced. Physicians and nurses should take care to avoid making promises, especially when an outcome is unknown, complicated, or difficult. A simple example of this occurs when a physician or nurse tells a patient that a procedure won't hurt ("No this shot won't hurt a bit"). Thankfully a Disney band aid and a lollipop will go a long way to fix that broken promise. The situation becomes much more complex when, for example, the patient asks you to promise not to let them die in the hospital/ amputate a limb/ lose functionality. Dr. Mikkael Sekeres shares the challenges when confronted with these fears: "But even when the compassionate part of me aches to alleviate my patients’ fears, I should know better than to make promises I can’t keep."

So when faced with these patient fears, what should physicians' and nurses' say? Start with empathy by validating their fears. Ask more questions about their fears and worries. Review their current condition and potential courses of actions. Reassure them you and your team will do your best, while not promising a specific outcome. Remember the other support services available, such as social work, child life, or a chaplain, to help those having a more difficult time coping.

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