Yep, this topic is one of my passions: trauma-informed medical care, trauma-informed systems of medical-care, and the problem of its frequent absence in health-care settings.
Guest author: Lesa Fichte, LMSW
Yep, this topic is one of my passions: trauma-informed medical care, trauma-informed systems of medical-care, and the problem of its frequent absence in health-care settings. I have met some wonderful, compassionate medical professionals. Yet I routinely encounter those whose attitude and behavior causes patient anxiety, emotional distress, fear, and is sometimes psychologically retraumatizing. Even though patient contact may be limited to only a few minutes, it is still possible to create trauma-informed experiences that benefit the patient.
Here are some examples of what is not trauma-informed medical care:
Some people have developed Post-Traumatic Stress Disorder (PTSD) from serious health issues, near death experiences and many trauma survivors in the healthcare system frequently have additional medical, behavioral health or mental health needs. How can the healthcare system address the needs of people who have had traumatic experiences that are impacting their physical health as well as their emotional health? To start, every healthcare professional should make themselves familiar with the landmark Adverse Childhood Experiences (ACE) study of 17,000 individuals that demonstrated the strong correlation between childhood trauma/abuse and adult health problems. Watch the fourteen-minute summary video of the ACE study.
Trauma-Informed Care involves a focus on “What happened to you?” instead of “What’s wrong with you?” While the healthcare profession typically focuses on individual diagnoses, symptoms, and treatments, I see the bigger issue as what is happening to people with medical issues, how it affects their ability to function and how it affects their quality of life. I frequently bring up the issue of quality of life with my physicians. I have never heard a medical professional talk about quality of life without me first raising the issue and bringing this perspective into the diagnosis and treatment process. TIC also encompasses the policies, services, and practices for both patients and staff. It minimizes the chance of individuals being re-traumatized by healthcare services.
The Fallot (2006) five guiding principles of Trauma-Informed Care apply to patients and the entire organization including the employees. I elaborated on the definitions to enhance their applicability to medical settings.
1. Safety: Ensure the physical and emotional safety of patients and employees. Shift to a whole person focus of “what happened to you?” instead of “what is wrong with you?” Make the physical environment welcoming, comforting, clean and safe. Value the patient’s experiences and perspectives so they feel safe. Ask them “how are you managing to cope with these symptoms/disability/pain?” Or perhaps “how is this affecting your work and home life?”
2. Trustworthiness: Provide clear and sufficiently detailed information about what patients and employees can expect and need to know; maintain appropriate professional boundaries. Return calls and requests for information consistently and in a timely manner.
3. Choice: Prioritize patient and employee experiences of choice and control. Give patients options including evidence-based options so that they can make an informed decision; respond respectfully to their questions as they clarify needed information to make an informed decision. Tell them why you recommend a particular treatment, listen to their questions, and let them make an informed choice.
4. Collaboration: Maximize collaboration and the sharing of power with patients and employees; it is the patient’s body so the final decision is theirs; work together with them in partnership; remember that other medical providers may be involved and multiple differences of opinions often occur that the patient must process; the provider seeks collaboration with involved other providers. Create a treatment plan together with the patient, follow it, and update it as desired by the patient through collaborative discussion. Listen to office and support staff ideas and concerns as they often have great suggestions to improve the practice and service for the patient.
5. Empowerment: Recognize patient and employee strengths and skills; acknowledge patient experiences and their inner wisdom regarding their health and employee ideas regarding service provision. Patients are empowered when they are given enough information to make informed decisions. Allowing the patient to be in the “driver’s seat” may feel uncomfortable to some, but it can be very empowering to many patients.
es, they are different although they have many similar components. A medical setting that has great customer/patient service is more likely to be trauma-informed for staff and patients, and less likely to trigger or re-traumatize a patient. However, TIC includes much more than just good customer service. In addition, there is the larger policy issue of identifying those children, youth, and adults who are trauma survivors when they enter the healthcare so that their needs can be effectively addressed with appropriate referrals and coordination of services.
So what kinds of things can make a medical or other healthcare setting trauma-informed? (Various resources are listed at the end of the blog.)
This topic could fill a book, but I hope I have offered enough to give you a good start! Check out some of the resources below.
Center for Pediatric Traumatic Stress, The Children’s Hospital of Philadelphia
National Center on Trauma-Informed Care
Brochure on Medical Traumatic Stress: What Health Care Providers Need To Know related to pediatric illness, injury and traumatic stress from the National Child Traumatic Stress Network
Medical Trauma from the National Child Traumatic Stress Network
The Adverse Childhood Experiences Study
Using Trauma Theory to Design Service Systems: New Directions for Mental Health Services, Maxine Harris and Roger D. Fallot (2001)
International Society for Traumatic Stress Studies
Traumatic Stress: An Overview, American Academy of Experts in Traumatic Stress
Online article: Some Medical Trauma Might Induce Later PTSD
Customer Service in Health Care Optimizing Your Patient’s Experience by Karen A. Meek
Video from the Cleveland Clinic on ‘Empathy: The Human Connection to Patient Care’.