A Primary Care Approach to Treating Women Without Homes

Roseanna H. Means, MD, MSc

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In This Article

Listening to Her Story

Taking a history from a homeless woman patient should include obtaining the facts pertinent to her presenting complaint, as one would do for a housed patient, plus other information that can contribute to understanding the context of her unique lifestyle. In most cases, the elements of the latter will need to be gathered over several visits, when the patient is receptive to sharing the information. Having the questions on a form in the chart helps the provider to keep all the data in an accessible location for easy reference (Table 4). One study in Massachusetts documented a past history of physical or sexual assault in over 92% of homeless women interviewed.[55] Providers of healthcare to women without homes can learn how to take a trauma history and provide support to these women.[56]

The goal of listening to her story and examining her body is to provide the basis for her returning, keeping in mind that the homeless woman's priority is day-to-day survival over disease prevention. The practitioner's priority is to create an environment that is nonthreatening and nonjudgmental, so that the foundations of trust can be laid. This requires patience. It means that at times it may be important to just listen, even over several visits. Listening to her story gives her experiences acknowledgment and validation. Compassionate listening builds trust, so that when it is time for the exam, the woman is less frightened.

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