{"id":18346,"date":"2019-09-13T10:54:11","date_gmt":"2019-09-13T15:54:11","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18346"},"modified":"2023-03-03T15:30:12","modified_gmt":"2023-03-03T20:30:12","slug":"how-to-make-doctors-appointments-better-for-trauma-survivors","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/healthcare-trends\/how-to-make-doctors-appointments-better-for-trauma-survivors\/","title":{"rendered":"How to Make Doctors’ Appointments Better for Trauma Survivors"},"content":{"rendered":"

Natalie Kraemer was 28 when she made her first gynecologist appointment. After being sexually abused by a boyfriend throughout high school, she avoided any situations that involved undressing or being touched. She\u2019d almost scheduled a Pap smear a few years earlier, but changed her mind after a massage triggered traumatic memories.<\/span><\/p>\n

Luckily, Kraemer\u2019s first time in stirrups went smoothly. After asking around and reading reviews, Kraemer picked an ob-gyn practice with a midwife. During her appointment, Kraemer let the nurse know about her sexual abuse. The nurse told her she could choose not to go through with the pelvic exam if it would be too overwhelming. Kraemer went ahead, and found that her midwife was just as considerate.\u00a0<\/span><\/p>\n

\u201cShe first examined my top half and then my bottom half so I didn\u2019t have to be totally naked or exposed,\u201d Kraemer says. \u201cShe explained everything before she did it, and she told me that she could stop anytime if I wanted her to. Then at the next appointment, she recommended against an IUD because she thought the insertion would be traumatizing for me.\u201d<\/span><\/p>\n

Kraemer didn\u2019t know it at the time, but her midwife practices what\u2019s known as trauma-informed healthcare.<\/span> It\u2019s a \u201cphilosophical approach where we understand the prevalence of trauma in our patients and ourselves, the impact trauma has on health and how that impacts the ways people interact with healthcare systems,\u201d says Dr. <\/span>Eve Rittenberg<\/span><\/a>, a physician at Brigham Health and an assistant professor at Harvard Medical School.\u00a0<\/span><\/p>\n

Trauma-informed healthcare isn\u2019t a new idea. But in light of the #MeToo movement and the related swell<\/span> of national conversations about sexual assault, <\/span>more practitioners<\/span><\/a> are looking for ways to help trauma survivors feel safe in the exam room. As a result, trauma-informed healthcare is becoming a movement in its own right.<\/span><\/p>\n

\n

Sixty-one percent of American men and 51 percent of American women report having been exposed to <\/span>at least one traumatic event<\/span><\/a> in their lifetimes. Trauma can seep into our health and well-being in varied, overlapping ways. Not only can trauma cause PTSD and contribute to mood disorders, addiction and other <\/span>mental illnesses<\/span><\/a>, it\u2019s also associated with a number of physical diseases. The relationship between trauma and disease is well-documented in research, most famously in the 1998 <\/span>ACE study<\/span><\/a>.\u00a0<\/span><\/p>\n

For this seminal study, the Centers for Disease Control and Prevention and Kaiser Permanente surveyed 13,494 people about their medical histories, lifestyle habits and adverse childhood experiences, or ACEs. These can include instances of sexual trauma, physical or emotional abuse, neglect, and living with an addict. More than half of participants reported at least one ACE \u2014 and higher numbers of ACEs corresponded to a greater risk for health problems such as heart disease, cancer, chronic lung disease and liver disease, as well as a considerably shorter life expectancy.\u00a0<\/span><\/p>\n

While trauma can make people more vulnerable to health problems, it can also make them less likely to seek out medical care. Going to the doctor, and dealing with all those pokes and probes, <\/span>might feel a little invasive to anyone. For <\/span>a survivor of sexual trauma<\/span><\/a> or <\/span>another form of abuse<\/span><\/a>,<\/span> the experience can <\/span>become a form of retraumatization<\/a>. In a recent <\/span>New York Times<\/span><\/i> story<\/span><\/a> about male victims of sexual assault in the military, one veteran who\u2019d been raped during basic training subsequently stopped seeing a dentist regularly. \u201cIt is difficult to have someone in my personal space hovering over me,\u201d he told the <\/span>Times<\/span><\/i>.\u00a0<\/span><\/p>\n

The underlying goal of trauma-informed healthcare is to help trauma survivors access care and learn how to feel comfortable being patients. In practice, providing this type of care can mean a lot of things, from educating patients on the potential health impact of their trauma to creating an environment where they feel empowered and safe. But the guiding principle is always the same: Care for patients comprehensively, as whole people, and try to understand the relationship between what\u2019s happened in their lives and what\u2019s going on with their health.<\/span><\/p>\n

Trauma-informed primary care providers can\u2019t and aren\u2019t supposed to replace therapists.<\/span><\/p><\/blockquote>\n

Right now, primary care is the priority in expanding trauma-informed services, although a growing number of specialists are embracing the approach too, says <\/span>Karen Johnson<\/span><\/a>, a licensed clinical social worker and the director of trauma-informed services at the National Council for Behavioral Health. Trauma-informed primary care providers can\u2019t and aren\u2019t supposed to replace therapists. Instead, they offer a gentle on-ramp for patients with histories of trauma to get the care they need.<\/span><\/p>\n

\u201cWhen we don\u2019t create environments that are trauma-informed,\u201d Johnson says, \u201cwe definitely risk missing opportunities to find out what might have happened in a person\u2019s life so we can open the door to possible pathways to recovery.\u201d<\/span><\/p>\n

At the beginning of an appointment, a trauma-informed practitioner will typically seek information about a patient\u2019s background, either by asking them to fill out a survey or relying on behavioral clues. Using what they learn, the practitioner will take measures to make the space feel safe and tailor the visit to the patient\u2019s needs. For trauma survivors, safety often means having choices \u2014 choices they might not have had during their initial trauma. Johnson says simple practices, like listening to patient requests and fears, taking their anxieties seriously, and offering alternative ways to conduct exams or tests, can be critical in encouraging patients to continue receiving care and adhere to treatment plants.<\/span><\/p>\n

If a patient has a negative experience or feels violated, they might not return, Johnson says, whereas a trusting patient-doctor relationship can lead to an ongoing and open dialogue about what works best for that patient. For example, a patient with diabetes who is afraid of needles might need an alternative method of insulin delivery to stick with their prescribed regimen.\u00a0<\/span><\/p>\n

\u201cIf an individual understands they can express concerns and won\u2019t be shut down, and a clinician is encouraging those conversations,\u201d says Johnson, \u201cthat leads to shared decision-making and increased adherence, which can help people learn to manage their illness.\u201d<\/span><\/p>\n

\u201cIt can be very hard to sit with stories of suffering, and as physicians, that\u2019s what we do.”<\/span><\/p><\/blockquote>\n

A greater understanding of trauma can also help clinicians avoid compassion fatigue and burnout, says Rittenberg, who leads trainings within her healthcare system for other providers who want to learn about the approach. \u201cIt can be very hard to sit with stories of suffering, and as physicians, that\u2019s what we do,\u201d she says. \u201cHaving an understanding of the way that our patients\u2019 stories might impact us and developing ways of coping with that, all of that is part of trauma-informed care.\u201d<\/span><\/p>\n

At this point, trauma-informed healthcare is still an informal, self-appointed designation; clinicians decide exactly how to implement its principles into patient care. But its imprint is becoming more visible across the healthcare system. Starting in 2016, the National Association for Behavioral Health teamed up with Kaiser Permanente to create resources for advancing organizational change in primary care settings. These supports include addressing topics like trauma screening, educating staff, and dealing with burnout and compassion fatigue. At the state level, the California Department of Healthcare Services is spending <\/span>$60 million<\/span><\/a> this year to train providers to screen for trauma in primary care.<\/span><\/p>\n

Johnson expects the movement to continue spreading and becoming more established in accordance with growing awareness of how common trauma is and how much it can affect health. \u201cThe fact that we know there is a high prevalence of trauma and [that it has a] significant impact on health across the life trajectory is just information you can’t unlearn,\u201d she says.<\/span><\/p>\n

For people interested in finding trauma-informed providers, Johnson recommends looking for specialists who advertise a focus on trauma. Additionally, the website <\/span>ACES Connection<\/span><\/a>\u00a0has a resource center and community forums where people share information about local trauma-informed services.\u00a0<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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