by Lisa Ferentz, LCSW-C, DAPA

This week I am in Sarasota, Florida with my family. This is the 23rd year that my husband and I are participating in a week-long conference run by American Medical Seminars, a wonderful organization that provides continuing education to medical professionals. Our week involves trainings for Primary Care Physicians on medical and mental health issues. This is always a particularly rewarding experience because, by and large, the doctors who attend this conference have had no formal training related to trauma, and are often astounded as they are given a new way to think about some of their more enigmatic patients. I am able to teach them how to make their patients feel emotionally safer and more physically comfortable during an office visit and examination.

These well meaning doctors don’t understand the impact that trauma has on their patients’ bodies. They never learned about the somatization of trauma, which is tragic, given that so many people wind up in their doctors’ offices with physical complaints that have no organic cause. They get labeled “hypochondriacs” and “difficult patients,” when their physical pain is really the body’s way of storing traumatic memories. Doctors underestimate the role they can play in encouraging patients to seek out the mental health support they deserve and need. Instead, some doctors get caught up in writing excessive prescriptions for pain medication, while others stop taking their patients’ complaints seriously.

These talks give me the opportunity to help medical professionals understand the red flags their patients exhibit that can be indicative of trauma including: dissociation; being triggered by physical exam; presenting with anxiety and affective disorders; sexual difficulties; somatization; crisis-driven family dynamics; and the inability to engage in self-care and follow doctor’s orders regarding healthier lifestyle changes. I am able to teach these caring medical professionals simple ways to include a trauma history in the normal history and physical they perform on their patients. Just opening their minds to the possibility that a patient was abused in the past or may still be in an abusive relationship can make a huge difference.

What I would like to empower all mental health professionals to do is find ways to educate physicians and nurse practitioners, and to work collaboratively on behalf of their clients to make their medical visits more comfortable. If you know that a client who has been sexually or physically abused is getting a pelvic exam, colonoscopy, mammogram or other invasive procedure, get their permission to talk to their primary care provider. Encourage that provider to take extra time, to remind the patient to breath, and to stop the exam if the patient gets tearful, triggered, or becomes dissociative. In some instances, it helps to have a safe significant other present for certain procedures, to ask that a female nurse be present, or even to advocate for a low dose of an anxiolytic so the client can get through the procedure without feeling overwhelmed. Anything we can do to help our clients get the medical care they need, while increasing their sense of safety, is a great gift for them. It also enables them to break the cycle of a lack of self-care, getting the mammogram, pap smear, or colonoscopy that could save their life.

Have you ever worked with a physician to help him or her learn how to make their patients less anxious? Please share your experience here in a comment.


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