A trauma-responsive approach to consultations, examinations and procedures

Healthcare asks a great deal of people.

We ask patients to describe intimate symptoms to someone they may never have met before. We examine painful parts of the body. We ask people to undress. We perform procedures while they are awake. We ask them to trust us, sometimes at moments when they feel frightened, vulnerable or out of control.

For many people, this is simply an uncomfortable but manageable part of receiving healthcare.

For others, it can be much harder.

Previous experiences — including experiences of trauma, abuse, illness or healthcare itself — can influence how safe someone feels during a consultation, examination or procedure.

Trauma-responsive care is about recognising that possibility and practising in a way that prioritises safety, choice, trust and control.

It does not require us to know somebody's history.

And it certainly does not mean assuming that their pain is psychological.

You don't need to disclose trauma to receive trauma-responsive care

One of the most important principles of trauma-responsive practice is that people should not have to disclose difficult experiences in order for healthcare to feel safe.

A clinician may never know everything that has happened in someone's life — nor do they necessarily need to.

Instead, we can build simple principles into everyday care.

Explaining what is going to happen before an examination. Asking permission before touching someone. Offering choices where choices are possible. Allowing someone to pause or stop. Avoiding unnecessary exposure. Checking that somebody understands what is happening during a procedure.

These are small things.

But when someone has previously experienced a loss of control, they can matter enormously.

Trauma-responsive care does not mean your pain is psychological

This distinction is particularly important in pain medicine.

People living with persistent pain are sometimes told that investigations are reassuring, that their symptoms are related to stress, or that their nervous system has become sensitised.

These concepts can be clinically useful. But handled badly, they can leave somebody feeling that their physical symptoms have been dismissed or attributed to their emotional history.

Trauma-responsive care should never become another way of saying:

“Your pain is happening because of what happened to you.”

Pain is complex.

Joint disease, nerve injury, inflammation, previous surgery, musculoskeletal problems, altered nervous-system processing, sleep, stress, physical conditioning and many other factors can contribute — often simultaneously.

Previous experiences may influence how someone experiences healthcare and how safe they feel within it. That is different from assuming those experiences explain their pain.

Why this matters particularly in pain medicine

Persistent pain can itself change someone's relationship with their body.

A body that once felt predictable may begin to feel unreliable or threatening. Movement may hurt. Examination may hurt. Previous treatments may have been painful or frightening. Some people have also experienced years of feeling disbelieved or dismissed before reaching a pain clinic.

Pain medicine can therefore involve vulnerability even for somebody without a previous history of trauma.

And some of the treatments we use — injections, examination of painful areas, positioning on procedure tables and interventions performed while awake — can involve a temporary loss of control.

That makes the way we deliver care important.

A technically excellent procedure can still be a poor healthcare experience if the person receiving it feels frightened, powerless or unheard.

Choice and control don't mean avoiding necessary healthcare

Trauma-responsive practice does not mean that examinations or procedures cannot happen.

Nor does it mean that everything will always feel comfortable.

Sometimes an examination is clinically important. Sometimes a procedure involves discomfort. Occasionally there are limits to the choices available.

The difference is how we navigate those moments together.

Where possible, I explain why something is necessary, what I am going to do and what the person may feel. We can agree how they would like me to communicate during a procedure and what they would like to happen if they need a pause.

The aim is not to remove every uncomfortable experience from healthcare.

It is to avoid taking away somebody's sense of agency unnecessarily.

Sometimes the smallest changes make the biggest difference

Trauma-responsive healthcare does not always require specialist services or lengthy conversations.

It can be as simple as:

• explaining before examining;

• asking rather than assuming;

• giving someone time to reposition themselves;

• allowing a support person to be present where appropriate;

• agreeing a signal to pause during a procedure;

• recognising that somebody becoming quiet, distressed or overwhelmed may need a moment rather than encouragement to “push through”;

• accepting that a patient may prefer not to explain why something feels difficult.

These practices are good healthcare for everyone.

For some people, however, they can make the difference between being able to engage with treatment and avoiding healthcare altogether.

Trauma-informed or trauma-responsive?

Both terms are used.

Trauma-informed care usually describes healthcare that understands the prevalence and potential effects of trauma and incorporates that understanding into the way services are designed and delivered.

I tend to prefer trauma-responsive when describing my own clinical practice.

For me, it emphasises something practical: not simply knowing that trauma exists, but being prepared to adapt the way I communicate, examine and treat someone according to what helps them feel safe.

It also avoids making assumptions.

I don't need to decide whether somebody is a “trauma patient”.

I can simply practise in a way that respects the possibility that there are parts of someone's story I do not know.

A different kind of safety

In medicine we think a great deal about safety.

We check medications. We prevent infection. We monitor blood pressure and oxygen levels. We use imaging to guide procedures and protocols to reduce clinical risk.

Those things are essential.

But there is another form of safety that matters too: feeling safe while receiving healthcare.

That comes from being listened to, knowing what is happening, having choices where possible and retaining a sense of control over your own body.

At Wye Sanctuary, my approach to trauma-responsive care has also been informed by my work with The Flying Child CIC, founded by Sophie Olson, which works to improve understanding of childhood sexual abuse and the importance of trauma-responsive practice.

You will never be expected to disclose experiences you would prefer to keep private.

You do not need to tell me your whole story in order to be treated with care.

Disclaimer:
This article provides general information and does not replace individual medical assessment or advice.