You know the old saying “Don’t judge a book by its cover?”
Well, the same is true when you assess a patient. Hi, I’m Dr. Cruz.
Early in my career I noticed a pattern with some of my patients. They often had multiple
health issues, were uneasy during office visits, and frequently visited the
emergency department. But worst of all - they never got better despite multiple
visits. Then, I realized something from an early age many of my patients were
exposed to trauma and adverse childhood experiences or ACEs. This includes
emotional, sexual, or physical abuse, violence, neglect, discrimination, poverty,
and other adverse events. ACEs are more common in the u.s. than you'd think.
In fact, 60% of US adults have one ACE, 25% have three or more ACEs, and 16% have
four or more. ACEs occur in all socio-economic groups but are more
common in low-income and minority populations. For young children, repeated
exposure to trauma can impact brain development and literally rewire the
brains response to stress. So, as they grow up, many struggle with issues
related to emotional regulation like depression, anxiety, or substance use
disorders. Trauma survivors are also more often at risk for chronic diseases,
behavioral health problems, and even suicide. Knowing all this, I began to
rethink my approach to care. Instead of asking patients "What's wrong with you?" I
ask "What happened to you?" Recognizing that life experiences are often a root
cause of poor health is integral to improving patient care. Trauma-informed
care has helped me take these experiences into account providing
greater insight into my patients needs and how to address them. Here are five
key ways that health care organizations can gradually integrate trauma-informed
care into their practices to help patients and staff. First, build awareness
and generate buy-in. Involve both staff and patients in
adopting a trauma-informed approach. Second, invest in a trauma-informed
workforce. Hire staff that embrace trauma-informed care and provide
training not only for clinical staff - but also for non clinical employees like
front desk workers or security guards, who are often the face of your
organization. Next, create an environment that is safe
and welcoming for patients and staff. Engage patients in meaningful ways. Ask
how they feel and listen. You can also build trust by involving them in their
own treatment planning. Finally, identify and treat trauma – consider a screening
approach that works for your patients and ensure that treatments and referral
sources are available. These changes take time, but each step improves our ability
to connect with and care for patients. Today, our patients appreciate the
changes we've made. Plus our staff is more in tune with patients, so work is
less stressful and more rewarding. Trauma-informed care — it can truly
transform the caregiving experience from being treaters to being healers.