Trauma Survivors and Medical Care
For many of us, a routine doctor visit may be a benign proposition, but for trauma survivors, the experience can feel terrifying, and may often be avoided at all costs. While trauma is experienced throughout the lifespan, the healthcare community continues to struggle with learning ways in which trauma affects an individual's health, relationships, utilization of the healthcare system, and ability to adopt health-related recommendations.
“We treat symptoms of pain,” says assistant professor at the UNC-Chapel Hill School of Nursing, Jessica Williams. “We aren’t really thinking about what might be the root cause of the pain.”
As a society, we are continuing to become acutely aware that complex trauma is a significant public health issue. The lack of trauma informed care is detrimental to one’s health, impeding on healing – both physically and psychologically. Evidence indicates socio-economic disadvantages, systemic discrimination, and other interrelated factors are key contributors that negatively impact health, and widen the gap with trauma survivors and healthcare engagement. Failing to consider complex trauma and its impact, inadequately addresses underlying health issues and may be even more re-traumatising and disempowering to patients, ultimately causing the cycle to continue. The disconnection between patient and healthcare provider equals mistrust of health services. This exacerbates all areas of healthcare, resulting in representations of ailments over a lifetime, and ultimately poorer health outcomes.
So, how do we – either as patient or practitioner – support trauma survivors during our healthcare interactions? First, we need to recognize and acknowledge the uniqueness of one’s trauma.
“Trauma is highly individualized and therefore the response is highly individualized. One of the mistakes we don't want to make is assuming that we can define somebody else's trauma,” notes Dr. Kanani Titchen, an adolescent medicine physician and pediatrician at the University of California, San Diego’s School of Medicine and Rady Children’s Hospital.
Putting patients in the middle of the conversation allows them to name the trauma for themselves and empowers them to create their own wellness plan. The move towards patient-centeredness in conjunction with weaving in biopsychosocial approaches for better patient outcomes, has made major advancements in health care.
It’s key for health care providers to recognize that trauma reverberates through so many aspects of the healthcare system and to be cognizant in actively designing care delivery that acknowledges that fact.
That being said, recognizing trauma also means unlearning stereotypes. Shedding ideas and dispelling myths of what trauma is supposed to look like such as expressions of sadness or negativity, or thinking that a patient who laughs throughout the interaction and smiles frequently, are not indicators of the impact of trauma.
To strengthen a trauma-informed approach, clinicians must observe what’s actually being communicated– often with non-verbal cues and body language, medical symptoms, etc. This may be communicated via feelings of shame, fear of avoidance. Providers must not only recognize these factors, but also unknown facts in a patient’s motivating actions – such as a history of trauma – and be mindful in integrating this information into how care is delivered and discussed.
We must not attempt to rescue the patient, but at the same time we don’t want to leave it up to the patient or the person to identify themselves as a victim or survivor of trauma.
It’s also important to note that a patient may be completely unaware of the impact trauma may have had on their life. Many affected by trauma do not fully understand their trauma until they are well on their way to recovery.
For example, a patient may think that an abuse tactic or relationship dating violence, emotional abuse such as manipulation or control by a family member is normal. A patient may simply lack the context for understanding that they are being victimized or that they are a victim of trauma, as these forms can be particularly insidious as normalized behaviors.
Another finding is the extreme frustration patients note of being told by doctors that their symptoms are simply ‘in their head.’ This dismissive comment can be retraumatizing to a patient and undermines and invalidates their reality.
Emphasizing safety is vital for practitioners – psychical, psychological and emotional. “Really helping patients to have a sense of autonomy and restoring a sense of control to that person and giving them choice and options,” notes Dr. Anita Ravi, a family physician, is essential in trauma informed care.
Key ingredients in Trauma-Informed care that providers can implement:
Involving patients in their treatment process
Screen for trauma –routinely
Train staff with trauma-specific treatment approaches - both clinical and non-clinical staff too
Engage in referral resources and partner with organizations
Regardless, we must as a society, shift the language used in the medical landscape as it influences both providers' practices and patients’ experiences. This concept is beneficial for both patient and practitioner. If the practitioner describes trauma in a way that helps to reduce stigma and accommodates low health literacy, patients in turn, may be more likely to trust providers and follow treatment plans.
Having the patient walk away from a healthcare encounter understanding how a patient's traumatic experience contributes to their overall health instead of solely focusing on the trauma in itself, will ultimately aid in progress. The goal is for patients to have no need to ask for trauma-informed care, that this one day is standard practice.
Resources
Jessica Williams: Adapting Health Care for Trauma Survivors - Carolina Center for Public Service
Key Ingredients for Successful Trauma-Informed Care Implementation (samhsa.gov)
Why doctors must grasp patients’ context in trauma-informed care | American Medical Association.
What doctors wish patients knew about trauma-informed care | American Medical Association
