Trauma in health care

In 1990 I did an additional International Diploma Humanitarian Aid (IDHA) and had the honour to listen to a presentation from a man from Iraq and a man from Uganda who were part of the lecturing team on there humbling and deeply shocking experience with trauma from violence. One of the men, a qualified doctor, had been repeatedly tortured for several months and bore physical, emotional and mental scars for life. I would never have know had they not shared their accounts. And that is the point.

The trauma lies buried until it is ready to surface for confrontation or unless it is triggered through associations - which can be seemingly unrelated or suprising.

I learnt that day, to always assume a patient in my care has trauma and to always explain what I need to do, why and ask for consent before I start a procedure. I learnt the importance of observing how they respond to what I am doing and to talk to them in a way that supports them to go through the procedure, some prefer distraction, others need more control by means of information and communication and, or the ability to influence what is happening.

When practicing integrative medicine, esepcially with complex cases, I always take a trauma and sexual history although we are generally not taught to think or ask about this in medicine. Even in psychiatry, a trauma history in my experience is not always explored just as in gynaecology or urology is a sexual history. Yet in my practice in New Zealand, over 80% of my clients reported trauma, the majority of which was sexual.

I am a big fan of Bessel van der Kolk's book, "The body keeps the score" and Gabor Matés valuable contributions in the medical field and mainstream about the relationship between traum and health.

I want to advocate a step further - I believe many doctors become doctors due to developmental trauma, experience trauma during training and while practicing, induce trauma in patients and through the ability to "cope" with the traumatic things we do to patients, frequently operate from dissociated frames which I hypothesis increase the risk of inducing more trauma in patients propgating the cycle.

A trauma informed approach to teh practice of medicine is missing and needs to be better understood through reserach and integrated into how we practice.

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