Practice What your Patient is Thinking

Growing up in care

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1085 (Published 16 March 2016) Cite this as: BMJ 2016;352:i1085
  1. Áine Kelly

Áine Kelly describes how she began to access healthcare again after humiliating childhood experiences

My first memory of the healthcare system traumatised me for life.

I was only 7 years old when the police arrived at my house to escort my birth mother and me to hospital. They said I had to undergo a medical examination because they had reason to believe that my mother and stepfather were physically abusing me. Several adults dressed in white coats stood around the examination bed where I lay naked, humiliated, and frozen by fear. Time dramatically slowed down as they counted, measured, and photographed every single bruise, cut, burn, and abrasion on my body. The professionals kept asking me how I received my injuries, but I couldn’t tell them with my birth mother in the room. Luckily, they decided that she and my stepfather had physically and emotionally abused me and I was placed into emergency foster care. This medical examination probably saved my life, but it affected my readiness to engage with healthcare.

As a child in care I was expected to attend health assessments at the hospital every six months. I would be told to strip down to my knickers and vest and perform tasks such as standing on one leg. I have no idea why—I found it humiliating and degrading—but I always did as I was told because my past had taught me that if I didn’t I would be beaten. I was compulsively compliant and self reliant as a child and would often go out of my way to please my carers. I couldn’t tell the difference between abusers and adults who were genuinely trying to help me.

As an adult, I am still wary of health professionals, but I have been fortunate to find a great general practitioner. When I first started seeing her she encouraged me to go back to her every time I needed to see a doctor. This was such a great way to start because it meant she was able to get to know me and understand my past. That way I don’t always have to refer to my history of abuse or repeatedly tell someone that I don’t know about my birth family’s medical history. There are still some routine tests that I’m too anxious to agree to, but she never judges my decisions. She simply tells me about the pros and cons and encourages me to think about it for the future. She is always smiling and looks at me when I’m talking so I always feel able to ask her even “silly” questions, such as the types of food I should be eating and how often. Growing up in care I was subjected to many different diets, none of which were particularly healthy.

As a doctor, you could help someone like me to realise that you are trustworthy by clearly explaining the reasons why you want me to do something and reassuring me that you will support me if I prefer not to. You may need to see me a few times before I feel ready to do what you are asking me to do, so don’t place too much pressure on me, otherwise I will only start to avoid you.

I always did as I was told because my past had taught me that if I didn’t I would be beaten”

What you need to know

  • When you ask for consent, don’t assume that it is easy for me to say no. Explain your reasoning, and let me know that you won’t criticise me if I refuse

  • Always ask me whether there is anything else I want to talk about. I may be too nervous to tell you about my real problem. If necessary, reassure me and ask me to book a longer appointment with you

  • Encourage me to come back to you in the future; that way you can get to know me and I may eventually learn to trust you

Footnotes

  • For series information contact Rosamund Snow, patient editor, [email protected]

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