Human Trafficking 2: Approach To The Patient

Abstract

Trafficking survivors most commonly cite the emergency department (ED) as their health care access point while previously trafficked. A majority of trafficking survivors surveyed report accessing medical care at least once while trafficked. ED physicians should adhere to guiding principles of care, keeping in mind at all times the need for patient privacy and the use of paced evaluations and neutral language. It is incumbent upon ED physicians to recognize both the clinician-related barriers to helping trafficked patients (which may include an underappreciation of the relevance of trafficking to clinical practice and a lack of education and training) and patient-related barriers (which range from restriction and confinement by their abuser to the patient’s own shame, guilt, and self-blame; distrust of authorities; and fear). Once the trafficked patient presents to the ED, the physician should acknowledge that the identification of at-risk and trafficked patients can be the first step toward prevention and assistance, respectively. No singular or defined set of diagnostic signs or symptoms has been shown to cut across all forms of trafficking with any degree of sensitivity or specificity, but familiarity with the potential indicators of human trafficking can help the emergency provider recognize patterns and raise the suspicion of trafficking. If a clinician suspects that a patient might be trafficked, the clinician should engage the patient in a trauma-informed and culturally sensitive assessment. This review contains 2 tables and 34 references Key words: commercial sexual exploitation, debt bondage, domestic servitude, forced labor, forced substance use, HIV, modern-day slavery, neutral language, patient privacy, posttraumatic stress disorder, trafficking in persons