Dear Colleagues,

In the last week, we have heard much about sexual violence as part of our national conversation. This may be causing distress in many people who have a history of trauma, and these people may be coming to you for comfort and advice. In few other jobs do we have the privilege of sharing this trust with another person. While an honor, receiving this information can cause empathy fatigue or even a sense of powerlessness if we do not know how to respond to it. This note is intended to help you feel more equipped.

If you find patients disclosing this information to you, remember to be supportive. Let them know that it must be so hard to share this information but is important for their healing, and you appreciate them doing this. If the assault was recent, you will want to offer screening and prophylaxis for sexually transmitted infections and pregnancy as well as encourage a forensic evaluation and psychological support. (If the patient is under 18, disabled, or elderly, we are a mandated to report this).

For those who were assaulted in the past, the effects can last indefinitely and include: new or worsening pain symptoms, headache, nausea, persistent fatigue, depression, anxiety, nightmares, and sequelae to traumatic brain injury if applicable. Other possible consequences are associated with sexual assault, such as higher proinflammatory biomarkers and an increased risk of stroke and heart attack. As important, trauma can cause a changed view of the world, and treatment for sexual violence can be most helpful if it renews a person’s sense of trust in the current environment.

Use this moment to encourage patients. Events like this can serve as an opportunity to better understand the pain of these (often old) wounds and to seek professional support and guidance to integrate and heal from these experiences. If patients are not in a place of readiness to seek treatment, encourage patients who feel helpless to mobilize around where he or she has agency and control. (There is always something we can do, or some way we can take action). We truly want our patients to be free from suffering, even if we do not know how to directly help them. If all else fails simply saying, “I want you to be free from suffering” can be healing for both patient and provider.

You are welcome to copy my EPIC Smart Phrase “SAResources” (see content below), and add any resources you think should be included in the comment section below. You may want to add the names of your favorite area therapists to the list. Just remember you are all wonderful people for wanting to help. Even if we cannot eliminate their pain, we can let our patients know that they are not alone and that we sincerely wish this had never happened.

In gratitude for your service,

Rachel Roberts, MD

Sexual Violence Resources

PTSD resources from the National Center for PTSD
(This has general information for veterans and the general public):

http://www.ptsd.va.gov/public/index.asp

• Informational documents as well as links to support and help
• PTSD Coach Online Self-paced, interactive, 24/7 access
• Video coaching
• 17 tools for coping with trauma triggers, symptoms, sleep problems, anxiety
• Mobile App: PTSD Coach Helps manage symptoms that commonly occur after trauma

National Sexual Assault Hotline 
24/7  1-800-656-4673
https://www.rainn.org/