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Physicians must create safe, trusting environment for sexual assault victims

Removing judgment and victim-blaming from the patient-physician interaction enables victims of sexual assault to open up more about their trauma and communicate their health care concerns, allowing physicians to enhance the quality of patient care, according to a new review.

“Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and emotional health,” Jane Balbo, DO, from the Ohio University Heritage College of Osteopathic Medicine, and colleagues wrote in the Journal of the American Osteopathic Association.

They added, “Sexual assault is associated with gastrointestinal, neurologic, and reproductive symptoms, as well as obesity, diabetes, and chronic pain. With one in three women and one in six men experiencing some form of unwanted sexual violence in their lifetime, sexual assault is a significant public health problem that necessitates attention in the medical community.”

Balbo and colleagues assessed more than 50 studies that evaluated posttraumatic stress and access to medical care among victims of sexual assault to determine how primary care physicians can better patient care.

Based on their review, the researchers advocated for trauma-informed care and practice techniques that focus on providing patients, providers and staff with a calm, safe and empowering environment.

“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,” Balbo said in a press release.

To allow patients to open up about their abuse, Balbo suggested that questions such as the following be added to the patient intake form: 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?

Additionally, Balbo recommended that physicians initiate a conversation with patients about recent or past negative experiences by giving them examples, such as bullying, unhealthy relationships and violent behavior. She noted that this type of dialogue may reveal sexual abuse and traumas that are missed in typical screening methods.

Balbo emphasized the importance of physicians responding appropriately to patients disclosing their history of sexual trauma. She advised that physicians assure patients that it is common to have gaps in memory following trauma if they cannot recall details of the assault. Physicians should not investigate the abuse, Balbo said, adding that forceful questions may make patients feel as though they are not believed or are to blame.

When dealing with patients who are uncomfortable talking about the abuse or reporting it, physicians should recommend that they speak with a confidential counselor, according to Balbo. Physicians should also give patients contact information for counseling and mental health services and offer to help schedule their first appointment, she added.

Balbo noted that since preventive medical care requires clinicians to touch and be close to patients, many survivors of trauma may be hesitant to seek such services. Thus, it is imperative that physicians explain why performing any type of hands-on care is necessary and what the patient should expect during the examination, she said.

“The physician’s goal should be to validate the patient’s experience, advocate for their needs and support their autonomy,” Balbo said. “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.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.