'Trauma Informed Care' Considers a Patient's Background to Offer Safe, Competent Treatment—Here's What to Know
Six years ago, while attending a routine ob-gyn appointment when I was 19, I discussed with a nurse practitioner the pros and cons of starting birth control. I decided that I wasn't interested, which clearly upset her. She pushed me to try NuvaRing, an IUD, or go back on the pill. I told her I didn't need it and grew more upset with each incredulous look pointed in my direction.
I didn't feel comfortable sharing with her that although I had dated a man in the past, the person I was interested in dating was a cisgender woman unable to get me pregnant. The provider was aggressively persistent with her questions: What if you start dating someone? What will you use for protection? What is your plan? My hands began to sweat as I felt myself reverting inward. I reassured her that if I was faced with a situation where I'd need birth control, I'd reach out to her to explore my options.
The provider shook her head, sighed, and said, "Don't make a stupid mistake."
Around that time, I had finally built up enough courage to start coming out to friends and family. I grew up in a rural, conservative small town, and I assumed that most people couldn't bring themselves to accept me for who I was. While I was met with a lot of positivity and support from those closest to me, a few people believed I was simply confused. Some thought I'd grow out of it, didn't believe me, or got on board apprehensively.
A family friend even warned that "the LGBT is a dangerous organization" and that I should "be weary of trusting them." I was hit with a variety of questions and comments: If you seriously date a girl and end up hating it, what are you going to do then? So you came out as bisexual, but when are you really going to come out as gay? How can you be sure? Don't tell anyone else about this.
These confusing and hurtful statements sent a message similar to the one thrown at me in that ob-gyn office: don't make this mistake. Shifting uncomfortably on the crinkly paper of the exam table, I can't remember if I felt afraid, angry, or simply numb—but I know that I didn't try to argue with her. Part of me felt like she and everyone else could be right, that maybe I couldn't trust myself.
Existing in a world where I felt unaccepted was difficult enough, but I didn't realize that trying to access health care could be another source of fear, guilt, or shame. As a registered nurse, I have not only seen this scenario play out from my own experience as a patient, but also as a provider navigating a problematic health care system.
That nurse practitioner in the ob-gyn office who assumed I was misguided in my decision to skip birth control revealed a level of ignorance exemplified by providers who are not held to a standard of competent, inclusive, trauma-informed care. Trauma Informed Care (TIC) is a practice acknowledging that many patients have gone through personal, systemic, and/or generational trauma that puts them at risk of being re-traumatized by a health care experience.
TIC encourages providers to avoid blaming or questioning patients, and instead consider their varied experiences in order to provide more holistic, safe, and competent care. While some institutions have emphasized the importance of TIC, not everyone applies it in practice. It's an unfortunate reality that homophobia, transphobia, and racism are not absent from medical practice. Sometimes, the deeply held biases of providers can stand in the way of progress.
As a registered nurse working on an acute-care hospital floor, I understand that health care workers are unfortunately set up to function in a fast-paced, task-oriented setting, often devoid of empathy. The cycle of witnessing trauma after trauma becomes, sadly, a normal part of our job. This not only leads to provider burnout, but it breeds an environment that can feel unwelcoming and intimidating for our most vulnerable patients. With high-stress and demanding situations consuming most of our days, we aren't often expected to consider our patients' emotional needs—even though a person's emotional well-being can affect quality of care and overall outcomes.
Forming a trusting relationship with a health care team can not only help a patient feel more empowered, but also create a more seamless experience for accessing care. Providers who implement TIC are actively working to avoid re-traumatization and cultivate a safe space for patients. The practice of TIC can include explaining procedures in a way that a patient can better understand, asking permission before touching a patient, or working to become more well-informed on medical transphobia, homophobia, sexism, and racism. Overall, the most important aspect of TIC is the act of listening instead of projecting.
I'm happy to say that now, as a 25-year-old, I have a wonderful team of providers who welcome me for who I am, and they clearly implement TIC in their practice. It's taken some time to find them, but I finally feel comfortable, respected, and safe in each office I walk into. There's space made for me to express my concerns, advocate for myself, and feel truly heard.
Although I encourage everyone I know and love to seek out care that mirrors this experience, I know that it's not always easy or attainable. This is especially true for trans folks attempting to access gender-affirming care, who are at risk of being turned away by providers or having their rights revoked by state legislators. This is why it's so important for all of us, patients and providers alike, to advocate for more inclusive care and to start conversations within our communities.
If you're looking for more information on TIC, I recommend checking out this site with easy to read info and even videos explaining this approach and how it can be used in practice (and recognized by patients). I also encourage patients to ask their providers if they know about or practice TIC, and if you're vetting new providers, it's completely fine to ask their office if they take a TIC approach before you actually book an appointment.
As a health care provider, I understand that sometimes we aren't at our best. I'm not always a perfect nurse, and I'm constantly in search of ways I can improve. However, my experience as a patient has given me a perspective on just how important mindful, inclusive, trauma-informed care is. For our queer and trans patients, for BIPOC, for sexual assault survivors, and many others who have been historically traumatized in medicine, there must be a greater effort to make competent care not just an asset, but an expectation.
We can all make room in our daily lives for a pause, a consideration, or a moment of patience. We can call out coworkers, leadership teams, and medical institutions when we see patterns of harm. We can uplift and make space for those who need their voices heard. As a nurse, I am actively challenging myself and my peers to do better; as a queer patient, I know I deserve better.