It’s no surprise that a number of recent events — from continued #MeToo era-accusations of sexual assault and harassment to the confirmation hearings of Supreme Court Justice Brett Kavanaugh — have elicited a number of painful memories for people across the United States.

Eve Rittenberg, MD, from the Fish Center for Women’s Health at Brigham and Women’s Hospital in Chestnut Hill, Massachusetts, works with patients who have experienced trauma, and has been working tirelessly to educate healthcare providers at all levels about the field of trauma-informed care.

“My patients’ experiences reflect the prevalence of trauma in our country,” wrote Dr Rittenberg in an article published in the New England Journal of Medicine. “More than one-third of US women have been the victim of contact sexual violence in some time in their lives.”

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It’s not always easy to tell whether someone is experiencing pain from national news reports. Dr Rittenberg, a primary care internist, encourages organizations to act thoughtfully when it comes to trauma-informed care.

To enact trauma-informed care in practice, she recommends internalizing the Substance Abuse and Mental Health Services Administration (SAMHSA)’s 6 principles: safety; trustworthiness and transparency; empowerment, voice, and choice; and consideration of cultural, historical, and gender issues.

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Following these principles can help patients feel comfortable and in control during an office visit. Physicians should aim to offer patients more choices and be as transparent as possible, asking, for example, if they would like the door open while waiting for the doctor, or like someone else to be in the room while the doctor is doing the examination? In addition, explaining each step of the process clearly can help build trust and make a patient feel empowered.

“As we are inundated with news about abuse, health care providers have an opportunity and responsibility to dig deep into ourselves and commit to actively resisting retraumatization,” to develop the resources to support survivors, and to support each other as we do this work,” Dr Rittenberg concluded.


Rittenberg E. Trauma-informed care — Reflections of a primary care doctor in the week of the Kavanaugh hearing. N Engl J Med. 2018;379:2094-2095.