Trauma-Informed Care — Reflections of a Primary Care Doctor in the Week of the Kavanaugh Hearing [NEJM.org]

Today, it was my third patient of the morning: a woman with a history of childhood sexual abuse and an abusive marriage. She shared with me her distress, her escalating nightmares and flashbacks over the past week. She held out her left arm to me, where for the first time since her adolescence, she had started cutting herself. And then my sixth patient struggled unsuccessfully to tolerate a Pap smear, as her anxiety became unbearable. Yesterday, it was my fourth patient, with a history of severe childhood trauma, who told me of the bullying at her workplace by her male boss. Stories of struggle and abuse, of trauma inflicted by people with power, have permeated my sessions with patients over the past couple of weeks. Many of my patients named the Kavanaugh hearings as a source of dread, which has been slightly tempered by admiration for Dr. Blasey Ford. The news in which they are immersed has resonated deeply and brought back memories of their own experiences.

I am a primary care internist, practicing in a women’s health group. My patients’ experiences reflect the prevalence of trauma in our country: more than one third of U.S. women have been the victim of contact sexual violence at some time in their lives. Sexual assault often starts early — 40% of women who have been raped were first raped before 18 years of age.1 In my work, I have the privilege of being present for women who share with me their fears, their hurt, their shame — and trust that I will stay with them and listen. The impact of my patients’ stories has led me to become involved in educating health care providers and staff about the growing field of trauma-informed care. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a trauma-informed organization or practice acknowledges the widespread impact of trauma and understands potential paths toward recovery; recognizes the signs and symptoms of trauma in both patients and staff; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and actively resists retraumatization.

[For more of this story, written by Eve Rittenberg, M.D., go to https://www.nejm.org/doi/full/10.1056/NEJMp1813497]