The Warren Alpert Medical School leads the country in training students to perform trauma-informed care.
Sadie Elisseou ’06 MD’10 calls her next patient’s name into the primary care waiting room on the first floor at the Prov- idence VA Medical Center on a cold, clear morning last December. As he approaches, she greets him with a broad smile and a warm “Good morning! So great to see you.”
The patient is a burly, broad-shouldered, middle-aged man who served in Korea, Afghanistan, and Iraq and has diagnoses of depression, anxiety, a traumatic brain injury, alcohol use disorder, and symptoms of post-traumatic stress disorder. For the next 40 minutes, Elisseou, an internist at the VA and assistant professor of medicine at the Warren Alpert Medical School, takes the patient’s history, gives him a high five to congratulate his sobriety, performs a physical exam to identify the source of the persistent pain in his lower back, and works with him to develop a treatment plan that takes into account his wariness of medications and the changes in VA coverage for a massage therapist he’s found particularly effective.
Elisseou asks each question, performs each maneuver, and gives each directive with professional precision and compassion. As she explains later, she considers every aspect of the encounter an opportunity to maximize her patient’s feeling of autonomy and safety. “I am going to reach behind you to get the otoscope,” she says, while maintaining a firm hand on his shoulder to establish her presence. After discussing his options for medication, massage therapy, and yoga, Elisseou walks him to the checkout desk, thanks him, and wishes him happy holidays.
Her carefully executed patient interactions fit into a named set of practices that are gaining recognition in the medical community. In September 2017, Elisseou introduced the trauma-informed physical exam framework, upon which these exam maneuvers are based, to the MD Class of 2021. She says there have been no published reports of curricular incorporation of trauma-informed practices at other medical schools—meaning the Warren Alpert Medical School may be the first in the country to include them in an undergraduate medical curriculum.
