An Introduction to Trauma-Informed Care

Two short Perspective pieces in the November 20, 2018 NEJM are excellent introductions to this subject.  They discuss how we, as health care providers, can serve our patients better.  Significant numbers of our patients were victims of violence that informs their general health.  This is a huge, underappreciated subject that we do not think enough about in our rush to get through our busy clinics.

1. Trauma-Informed Care - Reflections of a Primary Care Doctor in the Week of the Kavanaugh Hearing. by Eve Rittenberg. N Engl J Med. 2018 Oct 10.  Free Article

2.  Sit Back and Listen — The Relevance of Patients’ Stories to Trauma-Informed Care.  by Dorothy Novick. N Engl J Med 2018; 379:2093-2094 Free Article

Excerpts:

Rittenberg:

“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.  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

“Health care providers have an opportunity and responsibility to dig deep into ourselves and commit to actively resisting retraumatization, to develop the resources to support survivors, and to support each other as we do this work.”

Novick:

“If there is one thing I have learned over 22 years of practicing pediatrics in an under-resourced urban environment, it is that patients reveal their most personal and painful life experiences when we build trusting relationships and encourage open dialogue. The more we understand about the long-term effects of toxic stress due to adverse childhood experiences, the more important it becomes for us to absorb these stories. They form the crux of trauma-informed care.”

There is also an informative eleven minute online interview with Eva Rittenberg on providing patient-centered and compassionate care for people who have experienced trauma that can be accessed at either of the above links.

Sexual trauma is just one of the Adverse Childhood Experiences and Traumatic Events that result in victims' poor health and shortened longevity.  The ACE Pyramid is a useful summary.