Addressing Quality of Care

December 2021
By Rochelle Wempe, Legal Counsel,  Dr. Werner Oberholzer, Deputy Registrar, with input from Dr. Val Olsen, Quality of Care Senior Medical Advisor 
Trauma-informed Care

What is Trauma-Informed Care?

Trauma-informed care is defined as practices that promote a culture of safety, empowerment, and healing.  A visit to a medical office or hospital can be a difficult experience for someone who has experienced trauma. It is important to recognize how common trauma is and to understand that any patient may have experienced serious trauma in the past. 

Physicians should assume that most patients may have a history of trauma and should approach them with care and compassion to reduce any risk of re-traumatization

The goal of trauma-informed care is to treat people in ways that create physical and emotional safety.  It involves giving people choice and control over decisions that affect them and allowing them to build feelings of control and empowerment. 

Being trauma-informed means that you understand how common trauma is and how it affects people.  That knowledge can then be put into practice by re-evaluating and changing approaches that could re-traumatize people. 

The three key elements of a trauma-informed approach are:

  1. Realizing the prevalence of trauma.
  2. Recognizing how trauma affects all individuals involved.
  3. Responding by putting this knowledge into practice.

Being trauma-informed is about creating environments that help people heal from trauma and do not contribute to new difficulties.  A healing environment is one that doesn’t re-traumatize people or minimize their experiences.  It is important to think about and change any processes or practices that could re-traumatize people. 

What is Trauma?

Trauma refers to any experience that causes intense physical and psychological stress reactions.  It can be one or many events.  The stress reaction can be experienced by the victim, or by a witness to the event.  It is an experience that threatens or harms an individual and has serious negative effects on someone’s physical, emotional, social, and spiritual well being.  Some examples of trauma include child abuse or neglect, motor vehicle accidents, job loss, sexual assault, physical assault, medical treatments, natural disasters, torture, poverty, suicide, intimate partner violence, cumulative trauma, and emergency worker exposure to trauma. 

How common is trauma?

In Canada, ½ of all women and 1/3 of all men have survived one incident of sexual or physical violence.  It is predicted that ¾ of Canadians will experience at least one potentially traumatic event in their life. 

Why is trauma-informed care important?

Trauma can put people at greater risk for physical illnesses such as cardiovascular disease, respiratory disease, chronic pain, diabetes, gastrointestinal illness, and cancer.  Trauma is also linked to an increased risk of mental illness including addictions, depression, post-traumatic stress disorder, personality disorders, and suicide.  Trauma is also related to higher incidences of homelessness and incarceration.

Often people develop harmful behaviours in an effort to manage the effects of trauma they have experienced.  For example, self-harm and substance use can relate to past trauma.  Possible signs of an acute trauma response include the following:  startle responses, flinching, shaking, staring into the distance, becoming disconnected from present conversation, losing focus, inability to concentrate or respond to instructions, inability to speak, sweating, change in breathing (breathing quickly or holding breath), muscle stiffness, difficulty relaxing, floods of strong emotions and rapid heart rate.

What does trauma-informed care look like? 

What can I do, as a physician, to improve my care of patients affected by trauma? Some DO’s of trauma-informed care include:

  • DO explain why an examination needs to be performed;
  • DO explain what the exam may involve and provide an opportunity for the patient to ask questions;
  • DO tell patients that if they need the physician to stop the exam, they can tell them so;
  • DO allow patients to bring a trusted friend or family member into the examination room with them; and
  • DO be cognizant of how past trauma and cultural background may affect the patient’s perceptions, reactions and understanding. 



“I’ve learned that people will forget what you said,
people will forget what you did,
but people will never forget how you made them feel.”
- Maya Angelou


For further reading on this topic, we would suggest the following resources:

Alberta Health Services, Trauma Informed Care (TIC) Information for Health Professionals

Manitoba Trauma Information and Education Centre

Centre for Excellence for Women’s Health, Trauma Informed Practice Guide

College of Physicians and Surgeons of British Columbia, Trauma-Informed Care Resources

College of Physicians and Surgeons of Ontario, Advice to the Profession: Maintaining Appropriate Boundaries

Centre for Disease Control and Prevention


  Rochelle Wempe is Legal Counsel for the CPSS.  She holds 18 years experience as a Crown Prosecutor dealing with all forms of trauma, has taken a seminar, The Neurobiological Consequences of Trauma: A Trauma Informed Approach, by Dr. Lori Haskell, at CPSBC in Vancouver 2019, and has been a Speaker for Victims of Crime week on trauma-informed approaches to sexual violence (2020).

  Dr. Werner Oberholzer is Deputy Registrar with the College of Physicians and Surgeons of Saskatchewan and specializes in Family Medicine, Emergency Medicine, and Care of the Elderly. 

  Dr. Valerie Olsen is Senior Medical Advisor with the Quality of Care Department at the CPSS. Her specialty is general surgery.