Trauma-Informed Approach to Physical Exams: Ensuring Patient Comfort and Trust
In healthcare settings, a trauma-informed approach isn't just a “nice-to-have,” it's an essential framework for providing effective and sensitive care to individuals who have experienced trauma. Having a trauma-informed medical visit, rather than a standard one, can deeply influence a patient's experience and outcomes. This holds especially true during physical examinations, where any patient may feel vulnerable and exposed, and for trauma-exposed individuals, these feelings can be even more pronounced.
In April 2024, the U.S. Department of Health and Human Services (HHS) made a significant — and necessary — step in the right direction as it relates to patient privacy and protection, by announcing that hospitals are required to obtain written informed consent from patients before conducting sensitive examinations, such as pelvic, breast and prostate exams.1 This mandate is particularly emphasized when patients are scheduled to undergo these exams while under anesthesia. Though it begs the question, “Why wasn’t this a mandate before now?,” it underscores a long overdue recognition of the profound impact of personal and historical trauma on health, as well as the potential for medical encounters to be distressing, re-traumatizing, or even newly traumatizing. Most of all, it highlights the need for greater sensitivity and respect for patient autonomy.
Outside of mandates and other requirements, there are other ways that healthcare providers can create an atmosphere of safety and understanding that promotes trauma-informed care. Whether you’re a practitioner or a patient, below are some strategies that foster a supportive environment, specifically for physical exams:
1. Ensuring Clear, Two-Way Communication: In an effort to alleviate anxiety and build trust, clinicians should explain each step of the physical exam beforehand, including what they'll be doing and why it's necessary. This transparent approach should continue throughout the exam by checking-in with the patient to ensure their comfort and addressing any issues that arise. This includes taking note of non-verbal cues, such as body language or facial expressions that may indicate distress or discomfort. Keep in mind that communication goes both ways; providers must allow space for patients to express their concerns or ask questions from the onset and encourage open, ongoing communication.
2. Respecting Patient Autonomy: Help patients feel respected and in charge of their own healthcare journey by empowering them with choices and control over the exam process. Informed consent isn’t something we should obtain only for surgeries—it’s relevant for physical exams, too. Informed consent must be freely given and can be revoked at any time. When and where appropriate, practitioners can invite the patient to specify alternatives or preferences for the examination environment, such as inviting a support person or loved one to be present, adjusting the lighting, holding or inserting devices on their own (ex. speculum), listening to music or other distractions, and shifting body positioning. By taking the patient's feedback into account, clinicians show that they value their input and are committed to providing care that is tailored to their individual needs.
3. Trauma-Sensitivity Training: In a “perfect world,” all healthcare providers should receive regular training in trauma-informed care, especially given the widespread occurrence of traumatic life events in our global population. Knowing that this “perfect world” isn’t reality (at least, not yet), the onus is on organizations to start implementing training programs on trauma-informed care for their healthcare staff. This training should include education on the prevalence and impact of trauma, as well as strategies for creating a safe, supportive, and healing environment for both patients and employees.
4. Trauma-Informed Language: In addition to standard communication techniques, such as limiting the amount of medical jargon used, being mindful of word choice during the exam is crucial to avoiding triggering or retraumatizing patients. This means using terms that are factual, descriptive and nonjudgmental, without adding unnecessary connotations. For instance, instead of asking patients to sit on the “bed” and place a “sheet” over their lap, which can frame the exam in an intimate manner, consider calling it an “exam table” with a “drape”. Rather than informing a patient that their body “looks great”, perhaps note that everything appears “healthy”.
5. Follow-Up Support: Extending contact beyond the actual appointment time can speak volumes about a practitioner’s level of care and leave a lasting impression for patients. This could include providing information on local support groups, referrals to specialized practitioners, counseling services, or follow-up from a team member. Individuals who struggle with physical exams or procedures (ex. dissociation during a pelvic exam) may benefit from a follow-up phone call or clinic visit, whether by the examiner or an allied team member. By offering resources and support services to individuals who may benefit from additional assistance, healthcare professionals can demonstrate that they are invested in that person’s continued health.
Ultimately, trauma-informed approaches to physical exams are not only about improving the patient experience in the moment, but also about supporting long-term healing and well-being. We all stand to benefit from collaborative healthcare settings. By prioritizing empathy, safety, and dignity, healthcare professionals can create environments where patients feel respected, empowered, and more likely to engage in their care.