Trauma Informed Care
Do you know what it is? Recently I helped a family medicine fellow write an essay about the topic--a story about how patients who suffered trauma helped her be a better doctor, pay attention to the language she used and how she conducts exams. Working with her was a wonderful reminder of the gifts patients have shared with me, their honesty and vulnerability, when I have inquired.
Trauma informed care means recognizing that many people have a history of physical, sexual and/or emotional abuse and what we do as clinicians and/or how we talk may trigger memories of those negative experiences. Fifteen years ago trauma informed care was mentioned in the mental health and social work literature. Eventually it entered medicine. Now a large body of literature exists on this topic. In summary, it is common. Clinicians should ask and follow up on clues. Sometimes that means helping the patient connect the dots between the trauma history and their current symptoms or challenges.One of the biggest studies drawing the line between trauma and health was done at Kaiser and looked at adverse experiences during childhood on thousands of middle class patients. This is referred to as the ACE studies. Physical/sexual/emotional abuse, a parent in jail, a parent with a mental health problem are a few of the adverse events. The more an individual had, the more likely the mental and physical health consequences.Unfortunately, even in the US, we are surrounded by violence and abuse. There was Charleston and now Thousand Oaks.
Many of us listened to sound bites from the Kavanaugh hearings. I was riveted by Dr. Blasey-Ford’s memories some 40 years later—her desperation at not being able to breath and the sound of the boys’ laughter. The recently elected governor of Michigan gave an emotional speech on the floor of the Michigan Senate back in 2013 about her sexual assault during college when a bill that banned insurance coverage for abortion in private health plans was up for a vote. Today I met a 21-year-old who is struggling to move forward with college classes because she internalized continued reminders about her inadequacies from a parent throughout her childhood. Men are not immune. Think of the victims/survivors from sexual abuse by clergy and war veterans. This week a 30-year-old with a learning disability finally told me that he didn’t want to use insulin for his diabetes because he watched his mother die from diabetes and she used insulin.Here are some hints when working with patients/clients to avoid triggering reminders of past traumas:
Watch language: I am not using a tongue blade, I am using a tongue presser or pusher.
Ask permission: Can I listen to your heart now.
Check past experiences: is there anything I need to know about your past pap smear experiences?
Watch for clues and cues: It seems like you are having trouble talking about x, is there something I need to know.
Bad things happen and can happen to all of us and they leave scars. It is both burden and privilege to understand the impact of trauma on patients’ lives. Part of healing for the patient is sharing and having someone hold their story. Ironically, the privilege of healing is being trusted as the holder.