Unfortunately, trauma is a nearly universal experience: Estimates suggest that about 90 percent of the population has experienced an event or circumstance that caused physical, emotional or life-threatening harm.
Everyone’s response to trauma is different, and these experiences can affect our health in ways that can be difficult to predict or understand. You may not realize that something from many years ago has an impact on your current health habits, relationships with others or even your comfort level in a medical office.
A trauma-informed care provider seeks to understand that impact and take steps to ensure you feel safe in the healthcare setting.
“Trauma-informed care is about providing excellent care for you,” says UNC Health internal medicine doctor Amy Weil, MD. “Without insight into trauma, medical care can reproduce or trigger trauma. In caring for patients, it’s an essential thing to consider.”
We talked to Dr. Weil and UNC Health certified nurse-midwife Rebeca Moretto about what trauma-informed care might look like for you.
How Trauma Affects Health and Medical Care
There is a wide range of trauma that people can experience in their lifetime. Examples include physical, emotional and sexual abuse; neglect; living with someone with a mental health disorder or substance abuse disorder; violence in a community or war; natural disasters or catastrophes such as fires, floods or terrorist attacks; witnessing a person being badly injured or killed; an accident or assault; and oppression or discrimination based on identity.
Experiencing trauma has been linked with poorer health outcomes. Children who experience trauma are more likely to smoke, drink, use drugs, experience depression, have a history of sexually transmitted disease and be obese and physically inactive as adults. These risk factors increase the likelihood of heart disease, diabetes, lung disease and certain cancers.
“The stress of trauma affects all body systems,” Dr. Weil says. “Doctors can perform tests related to health concerns, but when something doesn’t add up, it’s worth considering that traumatic exposures a person may have had are contributing to the situation.”
Medical care can cause trauma if you don’t feel properly cared for or heard. And even if you are in relatively good health, the experience of receiving medical care may not be easy for someone with past trauma.
“A medical encounter can be a frightening experience,” Dr. Weil says. “There can be power dynamics between a doctor and a patient. There are personal questions. You are often asked to remove your clothing and be examined in intimate places. Some of our treatments might cause pain. It’s important to make patients comfortable and do only what’s necessary and agreed to by the patient.”
What Does Trauma-Informed Care Look Like?
With any medical visit, you should feel comfortable, safe and able to speak up about any concerns. A trauma-informed care approach takes some active steps to ensure this is true for all patients, some of which you might not even notice. Questions about whether you’d like a support person with you or if you’d prefer a door to be open or closed are ways to ensure that you feel secure. These providers will also understand that starting an appointment in a medical gown can be scary.
“You can ask to not remove clothing before you speak to your provider or to have a get-to-know-you visit without an intimate exam or before the provider touches you,” Moretto says.
Your appointment may start with a conversation and small talk with your provider. Not only is your provider working to earn your trust and getting to know you, they’re also scanning for any signs that you’re anxious or uncomfortable; some people with past trauma might start sweating, shaking, or become tearful before or during a physical exam.
If you don’t feel ready to proceed with a physical exam or screening after that conversation, that’s OK.
“No one should have a physical exam pushed on them because it’s protocol,” Moretto says. “You should feel empowered to say, ‘That’s not going to work for me today. Is there another time?’ A provider should look at how they can support you that day, which includes stopping if things get overwhelming or scary.”
If you do proceed with a physical exam or screening, a trauma-informed provider will want you to know what is happening and why—so if a question seems too personal, your doctor may explain why they’re asking (and won’t be offended if you ask for an explanation or choose not to answer). In addition to offering you the opportunity to have a support person, it is now standard of care for all patients to have a chaperone staff member in the room for intimate exams. Your provider may narrate what they’re doing during exams or procedures and ask for your consent to be examined or to proceed to the next step in an exam. That’s true even in emergency care.
“I have seen people who have had really challenging experiences in birthing that could have been traumatic, but they don’t feel the experiences were traumatic because they were informed every step of the way, and they felt like they were an active part of the team,” Moretto says. “There can be a breakdown of trust when things feel like they are happening to the patient without consent or an explanation of why. In a true emergency, drawing out that conversation is hard, but it’s still about taking a moment to say, ‘This is scary, I’m sorry it’s happening so quickly, but here’s why.’”
Moretto says that following that kind of medical emergency and at the end of every appointment, patients should be given an opportunity to debrief, ask questions, express their emotions or provide feedback on what could make the next appointment easier.
Finding a Trauma-Informed Provider and Talking to Your Doctor About Trauma
In recent years, there have been increased efforts to make trauma-informed care part of standard medical education, but not all providers have been trained on recognizing and responding to people who have experienced trauma.
If you’re looking for a trauma-informed provider, start by asking friends and family for recommendations or do some online research. Some providers may mention an interest in trauma-informed care in their bio, while others consider it their standard of care. Seeing the provider’s picture also may be important; depending on your situation, you may prefer to see someone who looks similar to you, or you may prefer someone very different from you.
Talking about a traumatic experience can be difficult, which trauma-informed providers acknowledge. At the doctor’s office, you can expect to be asked about a history of trauma, but if you share or how much you share, is up to you.
“We ask verbally during the rooming process, in our visit and on paper,” Dr. Weil says. “If someone says they have been exposed to trauma, we invite them to lead the conversation. We shouldn’t inquire about every detail, which is different from how we might ask about a symptom like a cough, where we ask lots of questions.”
Just telling your provider that you’re feeling nervous or worried about an appointment or procedure can help them help you. Your provider knows it may take some time for you to feel ready to open up about the experience and may give you additional opportunities to speak up for what you need to make your appointment easier.
“I tell patients, ‘You don’t have to tell me what happened, but if there are ways that our team can support you, whether that’s avoiding certain language or just being aware of something, we’d love to do that for you, now or at any point in the future,’” Moretto says. “It’s prioritizing the patient’s control and autonomy of the experience. Not every patient will share, or they won’t share until trust has been established.”
Talk to your doctor if you think trauma is affecting your health. If you need a doctor, find one near you.