With all the health care changes and challenges in today’s society, going to the doctor or dentist is difficult enough for the average person. With a history of childhood or adolescent sexual trauma, a medical appointment can become re-traumatizing if not handled with care by the survivor and provider. Think about it, some other adult is making decisions on the survivor’s behalf, touching their body, has their hands in the survivor’s mouth rendering them unable to make their needs known or leaving them in a place feeling unheard. Their sense of safety and control is being challenged.
The two most common types of appointments that can leave a survivor anxious or triggered are Dental and OB/GYN appointments. Dental appointments, can either remind survivors of past abuse surrounding their mouths, can cause pain leaving them feeling powerless or leaves them feeling trapped with someone in perceived authority. The OB/GYN usually reminds survivors of past abuse, can also cause pain, especially if there is scarring left from past abuse and again with procedures can leave survivor’s feeling powerless and trapped. These situations can set up a cycle of survivors avoiding the medical care they need (Ravi, 2017) and then when they go to appointments being riddled with anxiety, flashbacks* and body memories*. How can this cycle be broken and whose responsibility is it to break?
In, a perfect world the wounded would not be the cycle breakers it would be the healers. Unfortunately, we don’t live in a perfect world. Although there are many providers who are becoming trauma-informed* it is not the norm, yet. Therefore, most of the time, the responsibility lies on the survivor. So, we will explore what can be done before, during and after a medical appointment to prevent more harm and maybe even provide healing.
1. Call Ahead
Before an appointment, the first thing is to make a phone call to the office and ask if they are a trained trauma-informed facility. If they don’t know what trauma-informed means, then most likely, they are not trained. Some other words that might be helpful would be to ask if they have experience working with patients with PTSD or severe anxiety. When speaking with dental offices they would likely understand severe anxiety, if they don’t that is a red flag. Then research. Get online and search the provider's name see if there are any reviews of other people’s experiences with them. Ask around to trustworthy people, they may have seen this provider or know somebody who has.
2. Make Some Lists
Self-care is a cornerstone of healing for survivors and is just as important during this process. Writing out the questions, concerns, and topics to be addressed during the appointment decreases anxiety about forgetting details. Frequently when under stress survivors with PTSD can struggle with memory issues and brain fog, this strategy compensates for these symptoms and allows for success. Another important list to have is grounding techniques helpful in stressful situations. Some examples would be specific breathing patterns, focusing on objects in the room, counting backward and self-talk. There is a great list at www.rainn.com under flashbacks. Since flashbacks and body memories are the reactions frequently triggered during medical appointments, it is important to know in advance how to manage them. Practice these skills, having experience ahead of time would be helpful.
3. Know Your Rights
During, the medical appointment there are several strategies available to the survivor to decrease the likelihood of re-traumatization and help the appointment be as successful as possible. Importantly, THE SURVIVOR IS IN CHARGE OF THE APPOINTMENT. If the survivor says the appointment is over, then it’s over. No-one has to stay anywhere if they don’t feel safe, perceived or real. Letting the provider know at the beginning of the appointment, even if a trauma history is withheld, that medical appointments make the survivor anxious, allows the survivor to explain if they need to leave, practice grounding techniques or ask for a female staff in the room.
4. Bring Support
Bringing another person to the appointment can be especially helpful both as a support and as a second set of ears. During stressful times it can be especially hard to retain information so an extra person can listen and write down key information. Bringing the list of grounding techniques to refer to and the list of questions/concerns to address again will decrease stress and anxiety.
5. Prioritize Self Care
After the appointment self-care will again be the focus. The survivor would benefit from keeping their schedule free after the appointment in order to re-group. The support person will be important for safe transportation home if any sedating medications were taken for anxiety or if something triggered the survivor during the appointment. When the survivor is ready, taking the time to debrief with someone they trust is important, taking inventory of what worked and didn’t. Deciding what needs to change or not, and if continuing with the provider is an emotionally healthy choice. Not everyone can switch to a new provider, in this case looking at how to make the next appointment more emotionally safe would be the focus.
Medical appointments are difficult but necessary. There is strong data that trauma survivors have increased the risk of chronic health conditions due to toxic stress in childhood (Esden, 2018). A piece of that increased risk is also the avoidance of medical appointment seen amongst survivors (Ravi, 2017). None of the above strategies guarantees a smooth, trigger-free appointment, but it ensures the survivor is in charge of the appointment and empowered to take care of themselves in that appointment whether that means leaving, asking for a time-out or bringing an extra person. Trauma survivors have spent enough of their lives not feeling in charge, these tools can empower survivors to advocate for themselves, and with practice can be used not just in medical appointments, but in everyday life.
Glossary*
Body Memory- “refers to intense or prolonged physiological distress with an undetermined 'here-and-now' explanation. The physiological response to trauma is an intensely somatic experience. Some examples of the way that trauma manifests in the body are gastrointestinal pain, chest pain, light-headedness, tingling sensations, shortness of breath, and unspecified muscle pain” (Marich).
Flashback- “A flashback is when memories of a past trauma feel as if they are taking place in the current moment” (RAINN).
Trauma-Informed Care- “means treating a whole person, taking into account past trauma and the resulting coping mechanisms when attempting to understand behaviors and treat the patient” (Withers, 2017).
References:
Esden, J. L. D. (2018). Adverse childhood experiences and implementing trauma-informed primary care. The Nurse Practioner.
Marich, J. P. D., LPCC-S, LICDC-CS, RMT. Physiologic Distress or Body Memory.
RAINN. Flashbacks.
Ravi, A., Little.V. (2017). Providing trauma-informed care. American Family Physician, 95(10), 655-657.
Withers, M., PH.D., M.H.S. (2017). Trauma-Informed Care and Why It Matters. Psychology Today. Retrieved from Psychology Today website
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