In the fight against gender-based violence, awareness is health workers' greatest weapon – Caitlin Delavaine

As a doctor of the future, I no longer want to see the use of ‘trauma-informed practice’ as a flippant phrase, only needed to satisfy essay rubrics and exam-mark schemes; and instead see it for what it truly is: a way to change a patient’s life.

As we attempt to gain control of one pandemic, another silently spirals. Over lockdown, concerns over gender-based violence (GBV) have continued to significantly rise.

With the demand for long-term specialist support far exceeding resources available, healthcare workers must be able to support GBV survivors in times of crisis.

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However, despite medical professionals’ essential role in facilitating a survivor’s recovery, medical students, myself included, receive little training on how to recognise and respond to these patients. Action to remedy this oversight is needed urgently.

This draws the question: how can doctors, and future doctors like me, best help these survivors?

I believe the first step in providing support is identifying when it is needed. Many survivors are reluctant to disclose their trauma for fear of judgement or dismissal.

Remaining cognisant of appearance, body language and word choice during consultations is key. Query where that bruise came from; ask if that contact was consensual; consider why they might appear agitated or distressed.

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Although daunting, if survivors are not asked about their experiences, how will they be identified and supported? It is indisputably better to ask a hard question than let a dangerous situation continue unnoticed.

The damage caused by GBV can far exceed any acute injuries seen. Survivors can find themselves disenfranchised from social ties; lacking in financial support; engaging in more high-risk behaviours; and experiencing a decline in physical and mental health.

Taking a trauma-informed stance here is essential, whereby healthcare workers appreciate how survivors’ assaults affect all other aspects of their lives. While acknowledging this, doctors must also educate these patients on the impact trauma may have on their lives, allowing them to make sense of their experiences and needs. Through encouragement, education and support, survivors can be empowered to reclaim their bodies, health and lives.

The manner in which care is delivered is as important as interventions themselves. During their attacks, GBV survivors lose power over their bodies and minds. It is therefore crucial they remain in control of their medical consultations.

Simple steps can be taken to ensure this: gaining consent prior to performing procedures; explaining examinations, step-by-step, before and as they are conducted; and making the patient aware they can end the consultation, without need for justification, at any point.

It is equally important for healthcare workers to remember that each survivor’s experience is unique and a one-size-fits-all approach cannot be adopted when consulting with them. If in doubt, ask the survivor what they need to feel comfortable. Discuss if any phrases or forms of contact would act as a trigger. These survivors must know they are safe.

I acknowledge a 10-minute consultation does not lend itself well to addressing all a survivor’s bio-psycho-social needs. However, if used well, I do believe it is enough to significantly change their life. Doctors may not be able to answer all their questions; resolve every problem or even end their upset, however, for those 10-minutes they no longer have to feel alone.

Helpful resources for those seeking support related to this article’s contents. Please do reach out if you feel able, and know you are not alone.

Rape Crisis Scotland National Helpline (open 6pm-midnight, daily). Telephone: 08088 01 03 02. Text: 07537 410 027 Email: [email protected]

Scottish Women’s Aid (open 24/7). Telephone: 0800 027 1234. Online chat: womensaid.scot/contact-us/ Email: [email protected]

Caitlin Delavaine is a fourth-year medical student at the University of Glasgow

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