Physicians across many specialties are treating trafficked persons in their practice. Yet, they are not trained to recognize human trafficking or know how to intervene. Studies have shown that 88 percent of US-born sex trafficking victims reported receiving medical care while being trafficked. This puts health care providers in a key position with these vulnerable individuals to aid in identification, prevention and intervention, but only if they are educated about the clinical presentations of human trafficking. In an effort to increase health care’s capacity to fight human trafficking, I worked behind the scenes at my medical school’s simulation center, creating a clinical scenario centered on treating a trafficked person for my fellow students to learn from.
This case was designed to expose future physicians to the complexity of human trafficking. The simulation center provides a learning environment to explore uneasy feelings in difficult clinical scenarios and practice building trust. It is okay to become flustered and misspeak — this experience is formative; however, when the students are the practicing physicians in a few short years, stakes are higher.
Watching through the two-way mirror, I saw students grow. Most were courteous; however, few took the extra effort to build a certain degree of trust with their distracted patient sitting on the examination table. This patient’s clipped responses to questions often intimidated many students, leading them to shy away from asking heavy questions about her history with abuse.
Patients benefited the most from those students who were compassionate. Students who succeeded built a relationship by being empathetic. They looked beyond the exterior of a stoic young woman and offered her confidentiality, demonstrating respect for her decision to disclose. Their tone was non-judgmental and gentle when they took notice of her brandings that signaled her trafficking history.
I also watched as standardized patients shut down and students walked away unaware. Some sped through their mental checklist, forgetting that simply looking and inspecting the patient might tell them more than a blood test. Others took too direct an approach, demanding a more detailed history, only to be met with a wall of resistance and no new information.
Having finished some of my third-year clerkship, I do not think this latter group of students were wrong; they were only exhibiting much of what they learned on the floor and in clinic. In fact, it is likely that practicing physicians today may never have had a lesson on trafficking, as 63 percent of health professionals reported receiving no training on the topic in a 2015 survey. They may underestimate how powerful the patient’s social history can be. Cues such as suspicious tattoos, an overbearing chaperone, or delays in receiving health care may not be factored into their differential diagnosis.
This is the case in many clinical visits for trafficked persons. There was no magic combination of words students could use to make the trafficked patient leave her trafficker … at least not that day. The objective of the case was not for the student to learn how to be a knight in shining armor, but to discover the uneasy feeling of knowing that something is not quite right — a feeling that so many providers describe. With this unease it is crucial to introduce the concept of empowering patients and gaining their trust, understanding that each interaction with trafficked persons can build his or her resolve.
Empowerment is defined by the World Health Organization as “a process through which people gain greater control over decisions and actions affecting their health.” What I hope for when standing behind the glass is that students will understand that this interaction can help the trafficked person gain control over their decision to leave. That we, as health care professionals, are not here to merely tell patients that they must leave their trafficker. Rather, our aim should be giving them tools to be able to leave successfully, with their own self-reserve. One of the most important tools recommended is to give is access to the National Human Trafficking Hotline through 1-888-373-7888 or texting HELP or INFO to 233733. The lines are available 24/7 and connect victims to numerous resources across the United States, equipping victims with the knowledge to safely escape trafficking.
For the simulation case, the patient sitting on the exam table is a collection of narratives from individuals who have experienced human trafficking and survived. It is my goal that by interacting with this patient, students will learn from their missteps now and be able to see the signs of trafficking for what it is later. After all, being cognizant enough to recognize a patient in need of resources to advocate for their own health is all part of the job. Empathy and empowerment thereafter are crucial, but being able to provide such values takes practice and dedication.