Tips for Trauma-Sensitive Adult Patient Care
Trauma-Informed Physical Examination
The physical examination is a standard component of the majority of medical encounters. It can be an opportunity to establish trust and reinforce a sentiment of care between provider and patient, but can also expose patients to shame, vulnerability, and/or triggers of prior trauma. A trauma-informed approach to the physical examination involves language and maneuvers that help communicate respect and restore a sense of safety, autonomy, and trust. The following framework for a trauma-informed physical examination can be applied to all patient encounters, regardless of whether the patient has a known history of trauma.
This trauma-informed physical examination framework was developed by Dr. Sadie Elisseou, internal medicine physician, clinical instructor at Harvard Medical School, and expert in trauma-informed care.
This framework has been incorporated into first year medical school curriculums at:
- Harvard University
- Columbia University
- Boston University
- Brown University
- Albert Einstein College of Medicine
Overview
Before the examination - Set the stage for a sensitive exam
• Check your non-verbal communication
• Set an agenda
• Make it standard
• Identify concerns
• Ask about comfort
• Offer chaperone
During the examination - Perform a sensitive exam
• Attend to draping and modesty
• Introduce examination components
• Explain why
• Ask permission
• Stay within eyesight
• Respect personal space
• Use simple, clinical language
• Check in
• Use professional touch
• Be efficient
After the examination - Provide sensitive closure
• Express thanks
• Discuss results
• Ask for questions
Quick Tips
· Be polite and professional
· Explain the standard nature of the examination to be performed and its medical relevance
· Ask permission before proceeding
· Provide instructions using easy-to-understand, professional language (e.g. “I will now inspect the chest for any rashes” vs. “Now I want to look at your chest”)
· Utilize appropriate non-verbal skills (i.e. maintain eye contact, stay within eyesight)
· Avoid the phrase, “for me” (e.g. “lower your shirt for me”), and language which may have sexual connotation (e.g. “exam table” vs. “bed”)
Remain mindful of draping, patient modesty and comfort throughout the examination