5 Things Survivors of Abuse and Trauma Want Their Doctors to Know

In Recognition of Sexual Abuse Awareness Month

1. Treat Me As A Medical Care Consumer

I'm not comfortable being treated as a patient, in the traditional sense of the word. I may have been traumatized or abused by a person in a postion of authority over me as a child, and the dynamics of the docotr/patient relationship can increase anxiety and result in very poor communication or re-traumatization. Please speak to me with respect and kindness, and present information with the goal of achieving shared, informed decision making.

2. Ask Permission Before Touching

Please always ask my permission before touching me in any way. Many care providers follow this practice, but, especially when someone is in distress, or in labor for instance, people forget to ask and just carry on with the procedure. This can be extremely distressing for some survivors, and is often difficult to express in a crisis situation.

3. Choose Your Words Carefully

Many phrases often used in medical care settings might sound harmless, but for survivors of abuse, they may inadvertintely invoke traumatic memories. Phrases such as, "Just Relax.," "This won't hurt a bit," and "It's for your own good," can easliy be replaced with "Let me know when you're feeling ready for me to begin." Please don't ask me what my triggers are. The word 'trigger' can be a trigger for many people. It's simply not a case of asking me if I was abused, and then making a list my triggers, and then making a plan. It is much more helpful to ask me if there is anything about potential procedures that might be difficult or upsetting to me, and then work with me to meet my individual needs.

4. Is This Really Necessary?

Let's re-think the necessity of pelvic exams. With the possible exception of obtaining a pap smear, routine pelvic exams have been shown to have little to no value.

http://www.slate.com/blogs/xx_factor/2014/06/30/pelvic_exam_study_annual_well_woman_exams_have_no_medical_basis.htmlIf

If a person is experiencing problematic symptoms, then yes, information can be obtained, but it is becoming apparent that including pelvic exams with yearly physicals when no problems are presenting is not necessary, and potentially traumatic for many people. When a woman is in labor, checks for cervical dilatation are standard practice in most hospitals, but are generally not medically necessary, and can increase anxiety, which can actually slow labor's progress. Not to mention the potential for introducing infection. Most often, cervical checks are the result of doctor curiosity, having no bearing on the outcome. A woman can dilate from three centimeters to ten in an hour, five hours, ten hours, or thirty six hours. Checking won't affect the progress, and any experienced provider can see and hear when it's time to push.

5. You Probably Don't Know My History

How prevalent is trauma and sexual abuse? Estimates range from 25% to as high as 60% of people may have endured sexual abuse and traumatic experiences as children, and into adulthood. If you ask if I've ever been abused, I may prefer not to discuss it, or I may not remember the abuse. So it is critically important that health care professionals strive to provide care with empathy, kindness, respect and compassion to all who come to them for care. Above all, please educate yourself about childhood sexual abuse, trauma, PTSD, depression, and domestic violence. You may never get "comfortable" asking about abuse, or counseling survivors, but by prioritizing sensitive care, you will become a part of the healing process, a small change that will make a big difference.

Ann Whitman, CPM, NHCM