AAMC Reporter: November 2005

Anthony T. Ng, M.D., Assistant Professor of Psychiatry Uniformed Services School of Medicine; Assistant Clinical Professor of Psychiatry, The George Washington University

Viewpoint: "Hurricane Katrina's Not-So-Obvious Lessons"

There are already many lessons that medical educators and health care providers in general have learned from the devastation of Hurricane Katrina and the response to it. Some of the lessons are obvious — others, less so.

The more obvious lessons, of course, relate to the prevalence of physical and psychological trauma that followed the hurricane. Then we have the issue of "surge capacity," or the ability of health care professionals and others to handle a sudden and dramatic increase in human need at a time when essential medical resources, such as hospitals, have been severely compromised.

We also can see that medical intervention in a disaster can be adequate only when resources are well coordinated. And we should look at the role of communication. Clearly people must receive substantial information ahead of time so they will understand the potential health risks and how best to seek medical help if disaster strikes. Such communication should be sensitive to the populations involved, such as people with disabilities and those with specific cultural or language needs.

But another lesson impressed upon me in the aftermath of Katrina is that, from an educational standpoint, we have not given nearly enough attention to helping future physicians understand their roles in disasters. Neither I nor my peers in psychiatry, for example, were trained in medical school or during our residencies about what to do in a disaster. While we learned about diseases and how to treat them, there were no lectures or textbooks to guide us about what to expect in disasters — or how to assist people who suffered physically, psychologically, and socially because of them.

A disaster like Katrina affects more than individuals. It has wide-ranging implications for entire communities and population groups. Do we truly regard natural disasters as public health emergencies, demanding extraordinary planning and action to mitigate and prevent human suffering? While medical schools have given some attention to public health issues, we have not done nearly enough to emphasize and reinforce that perspective in preparing our future physicians and health care leaders. Tomorrow's doctors must learn the enormous medical, psychiatric, and social consequences that natural (and man-made) disasters can have. Physicians must learn to educate and empower patients through disaster preparation, so they know what to do if and when disasters occur — including how to seek help and how to start rebuilding their lives.

At the same time, medical educators must take a much closer look at the effects that disasters have on physicians themselves. In the wake of Hurricane Katrina, many doctors were exposed to tremendous secondary trauma. They witnessed death, destruction, and human suffering at levels they had never previously encountered — or prepared for. In addition, many doctors and other care givers were directly affected on a personal level, losing their own homes and belongings, as well as being displaced or facing the potential loss of family members who could not be accounted for. Some physicians, forced to evacuate stricken areas with their families, were unable to locate their patients or ascertain their safety.

As we know, there were numerous accounts of heroism by doctors who stayed behind — such as those at Charity Hospital in New Orleans — and by those from other areas who rushed to help. Surely many of us perceived a tremendous need. But did we also realize that sometimes the best of intentions can interfere with an appropriate medical response, perhaps even making things worse for an already disrupted health system? I wonder: Is the initial role of physicians in disasters perhaps to hold back until a more thorough assessment of the needs can be determined?

I am not sure if there is any right or wrong way for physicians to act in these circumstances. However, I believe medical school training has an important responsibility to bring such issues to the forefront for those being trained. Future physicians should be challenged to look at the ethical issues surrounding the roles of physicians in disasters, both personally and professionally. And they must be challenged to define their future roles in disaster.

Medical schools also must focus more on teaching their students about how various people, including health care professionals, are affected by the immense physical and psychological suffering that occurs in disasters. What sort of emotional toll can physicians themselves expect to experience, and how will that influence their ability to respond? What steps may they need to take to mitigate the impact of disasters on themselves? If medical school curricula focus only on providing care — but without addressing these other ethical and self-care issues — we risk doing a great disservice both to future physicians and to the disaster victims they may some day serve.

Physicians have important roles in disasters, but not only in the response phase. They also have a part to play in the pre-planning and long-term recovery processes that facilitate community resilience. The medical education community must not fail to prepare future physicians more thoroughly for the inevitable disasters to come.

Anthony T. Ng, M.D., is chairperson of the American Psychiatric Association's Committee on Psychiatric Dimensions of Disaster. He coordinated the APA's initial response to Hurricane Katrina and was part of a technical assistance team sent to Mississippi by the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services.

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