Trauma-Informed Care Deserves a Stronger Spotlight in Surgery

By Sara Campbell, OMS-IV

Trigger Warning: The following blog post contains mentions of sexual assault.

A few months ago, I was catching up with one of my close friends when she told me about a recent experience at an oral surgeon’s office for an urgent root canal revision.

“On the day of the surgery, I waited a long time in the operating room by myself. When the staff finally came in, they did not introduce themselves and basically moved in silence. I tried to explain that I have jaw pain to the doctor and staff, so I was concerned about it getting worse from the surgery, but they shrugged it off. Then, the doctor gave me the sleeping medicine without any warning, I passed out, then woke up by myself in a room with bloody gauze hanging out my mouth, where I was alone next to an exit for close to an hour while I was still really, really out of it.”

Eventually, her boyfriend found her in the room and took her home after they got confirmation that they could leave. Perhaps you think this sounds like a standard trip to a high-volume outpatient surgery clinic – that is what it initially sounded like to me. I thought this clinic might need a refresher in patient care and maybe a negative review on Yelp. However, no matter what our assessments of her experience may be, when we put our own judgements aside, one thing about her story remains indisputable: my friend felt alone, scared for her safety, and extremely uncomfortable as she faced multiple unknowns throughout the day of her surgery.

Recalling her history of sexual assault and subsequent PTSD, I realized how distressing the entire experience must have been for her. Over the next few days, I found myself ruminating on her words, and thought about how a “routine” trip to the operating room could potentially be a triggering and even re-traumatizing environment for a sexual assault survivor. I started to critically examine some of our current practices in surgery and think about how they could be improved by implementing trauma-informed care practices.

Trauma-informed care (TIC) is an approach to delivering healthcare that assumes most people have experienced trauma at some point in their lives and recognizes the need to acknowledge all of a patient’s life experiences to provide quality care. According to the Substance Abuse and Mental Health Services Administration (SAMSAH), there are six basic principles that guide TIC and can be applied to surgical situations, which I have listed below.

• Safety – The patient’s actual and perceived physical, psychological, and emotional safety.
• Trustworthiness and Transparency – Includes obtaining consent, explaining risks, describing all possible procedures and outcomes, knowing who will be present, and what to expect on the day of surgery and throughout recovery.
• Peer Support – Connecting the patient with support groups where the patient can discuss their surgery, experience, and concerns with people who have experienced it before or are in a similar stage of treatment.
• Collaboration and Mutuality – Addresses power dynamics between the patient, doctor, and staff; treating the patient as an equal and allowing opportunities to collaborate with the patient.
• Empowerment, Voice, and Choice – Making sure the patient knows that they always have a choice, their decisions are respected, and can be changed at any time; promoting patient autonomy.
• Cultural, Historical, and Gender Issues – Respecting intersectionality.

After doing an exhaustive search, I was surprised to find out that we do not have clear guidance on how to incorporate trauma-informed care in our surgical practices. That includes whether it is the day of the procedure in the operating room, preoperatively in the surgical clinic, or post-operatively in recovery. It is important to acknowledge that while TIC at its core is not meant to be a concrete set of instructions, specialties like obstetrics and gynecology have developed specific TIC considerations for routine encounters that necessitate pelvic exams or other gynecologic procedures. I wondered why, at minimum, general surgery didn’t have similar considerations for our analogous sensitive exams, including breast, rectal, and hernia exams, let alone for major operations requiring general anesthesia.

My friend who shared her story with me was scheduled for another surgery within six months of the initial procedure, but never returned out of fear that she would have a similar experience. Now, after two years since the first surgery, she is facing even worse dental problems requiring a more lengthy, complicated surgery. Similarly, after a quick Google search, it was easy to find numerous posts on forum websites from sexual assault survivors who were avoiding or delaying necessary surgical care because they were worried about re-traumatization or being assaulted by the surgeon or staff members while under sedation.

I am left wondering if we should take action to create concrete suggestions or guidelines for trauma-informed care in the OR. I hope that anybody who reads this post feels challenged to evaluate their own personal practices and contemplate how they could be improved to provide even better care to our surgical patients.

Bio

Sara Campbell is a fourth-year medical student at Michigan State University College of Osteopathic Medicine (MSUCOM) who applied to general surgery this match cycle. She serves on the AWS Instagram Subcommittee and helps host live interviews to promote the voices of women surgeons of all specialties. When she’s not at the hospital working a shift or flipping through Schwartz’s Principles of Surgery, she is probably at home with her fiancé cooking up a storm, cuddling with her two cats, or attempting to jog.