What does trauma-informed Primary Care look like to you?
Content note: This post involves mentions many forms of trauma including sexual violence, eating disorders, and types of discrimination.
If you spend a lot of time hanging around doctors, you might get the idea that what makes a great doctor is someone who knows a lot and works really fast. But if you talk to patients, most of them are just hoping for a doctor that won’t traumatize them.
You’re at home, you’re feeling sick, you’re worried something is seriously wrong. If your last trip to the hospital or the doctor’s office was a scary or humiliating experience, you might put off care as long as possible. Or until it’s too late. Starting my own practice has given me the freedom to ask, how can I make visiting the doctor a safe, positive experience for people who have been hurt before? Heck, even a neutral experience would be an upgrade.
Not to toot my own horn, but I’m pretty good at not traumatizing my patients. These are some strategies I use just as a matter of course, because it’s Thursday:
I welcome questions, and I’m skilled at demystifying health stuff. You should never leave feeling like no one has explained the plan.
I encourage patients to set their own limits when what I’m proposing doesn’t work for them.
Barring evidence to the contrary, I assume my patients tell me the truth (screw off, House MD).
I’m not dumb enough to claim I’m not racist or homophobic or ableist or whatever, but I do work on interrogating my own biases and counteracting oppression.
Obviously I don’t touch people without consent.
I encourage the use of supports that can be anything from your boyfriend to a fidget spinner.
I’m proactive about the pain, discomfort, or stress an examination or procedure might cause.
I’m always learning to do better but I’m mostly, you know, not a dick.
But what if the health care system itself is traumatizing? Your doctor could be Our Lady of Trauma-Informed Care herself, but it isn’t always about her.
Health care executives know that patients hate things like fruitlessly waiting to get someone on the phone who actually can help them or never getting a timely appointment, but your average executive has had a pretty secure life. I think they see those problems as annoying inconveniences. They don’t know how it feels to live in fight or flight mode. They don’t know how it feels to be powerless when you are scared. And they unconsciously build a system that assumes most patients are secure, un-traumatized people like them.
One of the principles of trauma-informed care is Universal Precautions. Much as we wear gloves whenever we handle blood rather than trying to guess who has Hepatitis C, we should make every patient’s care appropriate for a person with trauma, regardless of their history. Traumatic experiences are not rare. And asking someone about their trauma isn’t always the right move; sometimes it re-traumatizes someone to have to talk about the worst day of their lives when they’re not ready.
So here are some of the ways we’ve designed our routines and our clinic environment for trauma-informed care:
You can communicate with your doctor directly. Emails and texts go to Dr. Mirer. If you have an urgent issue, you can leave a voicemail for Dr. Mirer and she’ll get back to you as soon as possible. If you need an appointment we can usually get you in the same or next day. You are not just a cog in a machine here.
Recognizing that the lights, sounds, and smells of the clinic can be overwhelming to folks with sensory sensitivities and can trigger traumatic memories in others, we have low-sensory hours from 10:00-12:00. We are aiming for a relaxed, calming environment all day.
Patients often dread vaginal exams, whether because of gender dysphoria, a history of sexual assault or bad experiences with previous providers. Our exams are always chaperoned and you are welcome to bring a support person with you if you like. Patients have the option to follow along with a mirror so they can see what’s happening. They are also welcome to put on headphones, close their eyes and try to zone out until it’s over. You let us know what helps.
Everyone gets to communicate their gender, name, and pronouns from the jump. No more worrying that a receptionist will deadname you in front of a full waiting room. Are some 80 year old cis people confused about this? That’s ok, 80 year old cis people sometimes make great allies.
Speaking of waiting rooms they actually don’t get that full and you typically won’t spend too long there because we value your time. But if waiting or sitting still are stressful for you, you’re welcome to move around, or wait in your own car instead.
Getting weighed is optional, whether you have a history of disordered eating or not. If a precise weight is necessary for your care that day I’ll go through it all with you ahead of time and you can choose to get on the scale backward and not know your weight yourself.
I’m always looking for feedback and suggestions on other ways to make my patients feel safe. What other practices have helped you have a good experience at the doctor’s office?
To learn more about whether Presence Primary Care is right for you, schedule a free Discovery Call with Dr. Mirer.
