Checklist Medicine: Managing the Traumatized Identity in Difficult to Diagnose Health Conditions

• In Event: Unpacking biosocial approaches to stress & trauma - III

Abstract

Notions of trauma have come to penetrate how pathology, time, and suffering are governed, named, and medicalized. While the proliferation of trauma-informed practice has opened up a hopeful possibility for understanding bodies in relation to environments, histories, and structural conditions oft left out of US medical practice, the expansive clinical identification of trauma presents double-binds for patients. Despite growing social and clinical recognition of the ways trauma manifests in very “real” ways, patients with histories of trauma are still subject to intense marginalization within medicine. Those with contested health conditions often feel these tensions most acutely, as expansive understandings of trauma mean that it often becomes a default, totalizing explanatory category for that which cannot be explained via other, conventionally biomedically sanctioned, means. Drawing upon three years of ethnographic fieldwork with patients with contested illnesses in the US healthcare system and auto-ethnographic work on medical education, this paper examines the ways in which patients and clinicians negotiate tensions between formal nosological and embodied experiences of trauma. For many patients, histories of trauma—while salient sites for intrasubjective examination—must be strategically managed in the clinical arena. Describing how physicians are taught to elicit histories of trauma via the clinical interview—typically via a “checklist”—this paper attempts to describe the ways in which broad and uncritical attention to trauma further compounds challenges for patients seeking care.

Author

• Alli Morgan, Icahn School of Medicine at Mount Sinai