What's in Your Little Black Bag? | Patient Centered Care and Trauma Informed Care for Pediatric Patients

The little black bag stands out as an iconic symbol of a doctor. But what's in the bag? From the American Family Physician in a piece titled "AFP 50 Years Ago", a doctor's bag should contain:

" It is understood that all should have blood pressure apparatus, stethoscope, percussion hammer, flashlight, tongue depressors, and thermometers as well as sterile syringes and needles or equipment with which to sterilize them. Cotton, alcohol, and four tourniquets are essential. Some might carry blood counting equipment or culture media for throat swabs, otoscope, ophthalmoscope, catheters, sterile gloves, sutures, needles, scissors, and other such essentials."

Flash forward to today, would your doctor's bag contain the same items? So much of medicine has changed in the last 50 years, perhaps even the idea of a doctor's bag seems ridiculous and antiquated. Before you completely write it off, remember one important part of the doctor's bag: It was taken with the doctor as he saw patients in their homes. In their natural familial and societal environment. Today, one could probably argue seeing a patient outside the walls of a hospital or doctor's office may be as important and relevant as their illness or injury. Remembering that patients are people, today's doctors need to understand patients' bring a whole host of psychosocial risk factors with them to the hospital, affecting everything from their ability to understand medical recommendations to their financial or insurance constraints to, ultimately, their health outcomes.

What does this have to do with the doctor's bag? As medical care shifted from the home to the hospital and office, doctor's bags need to shift as well. Medicines need to be updated. Instruments changed. New tools added, as Dr. Khullar says, so doctors can provide medical care not only to the illness or injury, but to the afflicted patient and family as whole:

"Part of the problem is the tool kit we assemble during medical training. We’re educated largely in a biomedical framework. We diagnose disease with textbook knowledge and prescribe medications because those are the hammers we have.

But consider the skills I would need to be more effective in just this one clinic session: understanding social issues that contribute to health; marshaling support resources like case management, social work and rehabilitation centers; exploring my patients’ values and goals and encouraging behavior change; leading interdisciplinary care teams; employing new technologies and methods of patient engagement like telemedicine; and appreciating how health systems fit together to influence an individual patient’s care — from home care and community centers to clinics and hospitals. "

Educating doctors and nurses on trauma informed care provides them tools needed to care for both the physical and psychosocial well being of their patients. Practicing medicine from a trauma informed lens fosters trust and rapport between the doctor and patient, improves medical adherence and health outcomes. What would you put in your doctor's bag? Would you include the DEF Protocol? Share your thoughts on our Facebook page!

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