Viewing the world through a trauma-informed lens can be transformative. Even in daily life, I find it helpful. There are people who we might label as difficult, who seem angry and hostile. Of course, in daily life we don't necessarily have to interact with them. It’s not the same as seeing them in a consultation space, but I often find myself musing on it. Sometimes I just want to ask: what happened to you?
That’s not necessarily appropriate in the consultation room, at least not at certain moments, but there are times when we need to hold the thought and there are absolutely times when we must ask. We are often privy to those horrors as a GP; violence in all its forms shapes lives. We have been lax in asking in the past and domestic violence and abuse (DVA) is not easy to disclose. And, of course, GPs experience all of them too, as reported in this issue by Neil et al, who spoke with GPs who are themselves survivors of family violence.1
Empathising and ‘being nicer’ is not enough.2 We need system change to provide appropriate services. As MacLellan et al asserted in their study of the complexities of considering trauma in women’s health: ‘It is an ethical prerogative that trauma-informed enquiry is supported by trauma-informed services and support.’
3 Violence against women and girls (VAWG) has been invisible for too long, but as Feder et al noted last year: ‘Trauma-informed practice is still in its infancy in primary care.’
4 They also made clear that overlapping intersections such as deprivation, disability, substance use, and racism amplify the effect of the violence.
Trauma-informed practice asks what happened to you but sometimes the system never asks anything at all: the man experiencing homelessness not allowed to register at a practice; the young woman with a learning disability who never joins the register and so is never called for the health check that might have flagged problems that the national mortality review of deaths for people with a learning disability and autistic individuals keeps finding. As with DVA and VAWG, it is essential that lived experience informs the research that shapes the policies to address this invisibility.
We have never in the history of the BJGP had a special issue with a call for papers. We plan to change that, and we are announcing a special themed issue on the topic of violence against women and girls, with details of the call for papers to follow. Waiting for that evidence to arrive would be another kind of not asking.
Highlights
Research on inequality and invisibility features: dermatology in skin of colour, ethnicity and palliative care coding, learning disability registers and annual health checks, and the NHS Health Check and mortality. Three papers look inward: where women GPs thrive, prioritisation dilemmas, and what expected income does to job satisfaction. Editorials on denial of registration as a never event, avoidable mortality after LeDeR, and invisible impact of visible illness. Analysis takes on endometriosis evidence and childbirth-related PTSD. Clinical Practice covers new Scottish cancer referral guidelines. As ever, Life and Times will get you thinking.
Notes
- © British Journal of General Practice 2025
