Caring for the Abused Patient
Sexual abuse is an all-too-common phenomenon. The greatest of care must be exercised, therefore, in caring for all patients, because any one of them may be a survivor of rape, violence, or abuse. Remember the First Law of Medicine: "First, do no harm."
Patients who previously have been abused need to be treated with particular sensitivity and care, not only because they have been traumatized but also because, having once been abused, they have become more vulnerable to further abuse. "When a person has been abused and violated by caretakers . . . all relationships become infused with distorted sexual and aggressive elements." 1 Someone who has suffered abuse may have been left with a feeling of utter helplessness that makes it impossible to resist coercion; may have been led to believe that he or she is worthless except as a sexual plaything; or may have learned to think of sex as a currency with which to purchase affection and approval.
At least one in four Americans have been abused by the time they reach the age of eighteen. Thus, whether they know it or not, all doctors probably are caring for a significant number of patients who have been sexually abused. Chances are, however, that a doctor won't know which patients they are. Abuse survivors rarely identify themselves.
I heard a speaker--at a conference I attended in Toronto, in Ontario, Canada--who talked about his own experience of sexual abuse.
He is a Cree Indian, from northern Canada. When he was a child, it was common for the government to remove Indian children from their families when they were about six years old. And this is what happened to him: He was sent to a Catholic residential school. Naturally, there were priests there. These priests went around to each child's