Medicine in the wake of Kavanaugh

As a result of the Kavanaugh hearings, a primary care physician who practices in a women’s health group has been inundated with patients whose memories of abuse have been brought to the surface. “Stories of struggle and abuse, of trauma inflicted by people with power, have permeated my sessions with patients over the past couple of weeks,” she writes in the New England Journal of Medicine. “Today, it was my third patient of the morning: a woman with a history of childhood sexual abuse and an abusive marriage. She shared with me her distress, her escalating nightmares and flashbacks over the past week. She held out her left arm to me, where for the first time since her adolescence she had started cutting herself.”

The doctor says that her “…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.” She recognizes that health care services themselves, “with an inherent power differential between patient and physician” can also be re-traumatizing for survivors.

Sitting with these patients day after day has taken a toll on the doctor herself. “It can use up my emotional resources and leave not a lot of room for my family, friends, and community.” Doctors such as this one experience vicarious trauma, which she says can lead to compassion fatigue and burnout. Nevertheless, she is part of a movement to educate health care providers about the growing field of trauma-informed care which includes such principles as safety, peer support, empowerment, and trustworthiness. We are talking here of caring for patients whose past experiences may have left them unable to tolerate Pap smears. One example of trauma-informed care is simply asking the patient whether she prefers to have the door open or closed while waiting for the doctor.

Let's hope the medical profession is paying attention.

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