Medical Trauma on the Inpatient Medicine Service: Perspectives of Recently Hospitalized Patients, Residents, and the...

While trauma's impact on health and well-being is increasingly emphasized in outpatient and pediatric settings, less is known about how a patient's history of trauma, especially healthcare-related trauma ("medical trauma"), may shape experiences of safety, trust, and distress on a general internal medicine inpatient service.

We sought to understand how recently hospitalized adults experience safety, trust, and distress during hospitalization, and how resident physicians and interdisciplinary care team members perceive barriers to delivering trauma-informed care.

We conducted a qualitative study among recently hospitalized patients, internal medicine residents, and interdisciplinary care team members. Patients completed semi-structured interviews that explored recent hospitalization experiences and perceptions of distress, safety, and trust. Resident physician and interdisciplinary care team members participated in focus groups to explore experiences caring for patients with trauma histories. Patients were screened for adverse childhood experiences (ACEs) using the Philadelphia ACEs survey. Transcripts were analyzed using a quasi-inductive descriptive approach.

A total of 10 patients with high ACEs, 10 internal medicine residents, and 10 interdisciplinary care team members (5 nurses, 4 social workers, and 1 chaplain) participated. Patients highlighted medical trauma (healthcare-related experiences that resulted in prolonged emotional or psychological distress) as a relevant traumatic experience while seeking medical care. Three themes emerged describing how hospitalization could re-activate or compound existing medical trauma: (1) Hospital treatments sometimes retraumatized patients, especially those with prior medical trauma; (2) perceived bias influenced encounters for patients and challenged clinicians' responses; and (3) missed inquiry about prior medical trauma and clinicians' uncertainty about broaching it limited emotionally safe communication.

Medical trauma is an important and impactful phenomenon, often reinforced through routine care. Embedding trauma-informed strategies, such as screening for prior trauma, reviewing documentation for bias, and trauma-informed communication, may help reduce medical trauma and strengthen trust in inpatient general medicine care.