As sexual assault survivors are mobilizing around the country under the #MeToo hashtag and sharing their stories in droves on social media, it’s important that those stories find light and support in another setting: the doctor’s office.
A review published in The Journal of the American Osteopathic Association encourages physicians to screen patients for sexual assault to provide trauma-informed patient care.
“Giving the patient an option to disclose a trauma within the context of his or her medical history, and without having to immediately discuss it, will help survivors get the best possible care from their physician,” says co-author Jane Balbo, DO, assistant professor of family medicine at the Ohio University Heritage College of Osteopathic Medicine.
The authors analyzed more than 50 studies, including topics like post-traumatic stress and reduced access to medical care in sexual assault victims. The collective analysis provides primary care physicians with an understanding of the physiological and psychological reactions to trauma, as well as concrete guidelines for patient care.
The authors hope that recent high-profile sexual assault and harassment allegations encourage more survivors to share their experiences with their primary care physicians.
A recent Newsweek story on the JAOA review highlights the need for doctors to better understand survivors’ needs as patients. “#MeToo is not a trend, it’s a cultural shift,” Dr. Balbo told Newsweek for the story. “And because of that—because of so many people coming out—I think it will start to change the way doctors behave with their patients.”
Getting patients to open up
Dr. Balbo recommends adding specific questions to the patient intake form, such as the following questions used on the form at OhioHealth Campus Care Ohio University:
- Have you ever been sexually abused or raped?
- Have you ever felt afraid of your partner?
- Has anyone ever hit, injured, threatened, or tried to control you?
- Do you wish to discuss issues related to rape, incest, sexual abuse, or coercion?
She also suggests physicians directly ask patients about recent or past negative experiences, and to offer examples like bullying, unhealthy relationships and violent behavior. This conversation opens a dialogue that may uncover sexual abuse and traumas not covered by typical intake screening questions.
Knowing what to say
Responding appropriately to a patient with a history of sexual trauma is difficult for many physicians, according to Dr. Balbo, whose literature review offers some guidance.
- If a patient struggles to recall details about the assault, provide assurance that lapses in memory are common after trauma.
- It is not the physician’s job to investigate the assault. Asking forceful questions can make a patient feel like they are not believed or are to blame for the assault.
- If a patient is uncomfortable discussing the assault or reporting it to law enforcement, provide the option to talk with a confidential counselor.
- Provide phone numbers for counseling and mental health services in the community and offer to have office staff facilitate scheduling the first appointment.
Informed consent and checking in
Navigating physical contact is also a delicate process for physicians treating sexual assault survivors, especially for DOs who often use osteopathic manipulative treatment to diagnose and treat myriad conditions. Dr. Balbo says explaining the nature and purpose of applying any form of hands-on care, as well as what the patient might experience during the examination, is important.
“The physician’s goal should be to validate the patient’s experience, advocate for their needs and support their autonomy,” says Dr. Balbo. “Particularly for sexual assault survivors, we need to consider the mental and emotional impacts of their experience because it affects how they respond to being examined and, ultimately, it affects their overall health.”