Response to “ethically conducting hair examinations among individuals with hijabs''
Authors: Warda Abdi, Lisa Bateganya, Travis W. Blalock
Journal: Journal of the American Academy of Dermatology (2023)

To the Editor: We commend Ziad et al. for providing a thoughtful and patient-centric perspective on how to ethically conduct hair examinations among individuals who wear hijab.1Ziad A. Al-Zubi L. Response to "Ethically conducting hair examinations among individuals with Hijabs".J Am Acad Dermatol. 2023 Dec 21; (S0190-9622(23)03394-7)Abstract Full Text Full Text PDF Google Scholar,2Abdi W. Sow Y.N. Blalock T.W. Ethically conducting hair examinations among individuals with hijabs.J Am Acad Dermatol. 2023; 89: e273-e274Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar We welcome dialogue centered on engaging how to create environments of safety for patients. Trauma-informed care (TIC) is an empathetic approach that is utilized in certain clinical practices and patient situations. However, we want to underscore that utilizing TIC universally in patient care interactions could be a controversial approach. Dermatologic examinations through a TIC lens is a thoughtful way to provide medical care in contexts where the examination process can be perceived as invasive. Integrating this approach in patient care raises concerns of overgeneralization. Muslim women who wear the hijab may not associate their practice of modesty to require TIC. Their concerns related to modesty or gender-specific care would not be fully accounted for within the TIC screening process. Presuming that all hijab wearing patients are trauma survivors may lead to misunderstandings about their needs and preferences, potentially alienating patients who do not identify with a trauma narrative. The nature of TIC is to focus on prevention strategies that target people who are at risk for developing social, psychological, or other conditions because of their trauma.3Roberts S.J. Chandler G.E. Kalmakis K. A model for trauma-informed primary care.J Am Assoc Nurse Pract. 2019; 31: 139-144https://doi.org/10.1097/JXX.0000000000000116Crossref PubMed Scopus (49) Google Scholar This approach can be controversial when discussing Muslim women because it assumes their care preferences are associated with trauma. However, there are a multitude of reasons why a Muslim woman wearing a hijab would request gender-concordant care. The default approach to patient care being TIC overlooks unique factors influencing a person's healthcare preferences and comfort levels beyond a trauma history. Dermatologists should encourage a collaborative approach to care that leads to better patient care outcomes.4Zolnierek K.B. Dimatteo M.R. Physician communication and patient adherence to treatment: a meta-analysis.Med Care. 2009; 47: 826-834https://doi.org/10.1097/MLR.0b013e31819a5accCrossref PubMed Scopus (1677) Google Scholar Muslim women who wear the hijab are often misrepresented in mainstream media as being victims of oppression.5Shabir A. Khan T.A. Media as an instrument of reflection or distortion of the real life problems of Muslim women in India.J Soc Incl Stud. 2022; 8: 86-96https://doi.org/10.1177/23944811221096943Crossref Google Scholar Treating them primarily as victims of oppression through a TIC lens might inadvertently promote this narrative and subsequent bias. What might be perceived as a trauma-related concern could be completely unrelated to trauma and instead rooted in religious practices. Addressing disparities in care through a default implementation of TIC without considering individual needs in their care will only perpetuate further inequality. The one-size-fits-all approach is at risk of perpetuating existing disparities or creating new ones. In the case of Muslim women who wear the hijab, TIC could be overcompensating because there is a varying degree of modesty practiced among Muslim women. TIC may limit hijab-wearing women who have fewer care preferences. In appropriate settings, the benefits of TIC are evident, patient-focused, and empathetic. However, its universal application may overlook some unique needs of Muslim women, particularly those who wear the hijab. By assuming a trauma-focused narrative, TIC might limit patient autonomy and fail to address cultural or religious considerations shaping healthcare preferences. Achieving equitable and inclusive care demands a more nuanced understanding, one that embraces diverse perspectives and respects individual choices beyond a singular framework. None disclosed. Response to "Ethically Conducting Hair Examinations among Individuals with Hijabs"Journal of the American Academy of DermatologyVol. 90Issue 4PreviewTo the Editor: We commend Abdi et al's1 article, "Ethically conducting hair examinations among individuals with hijabs," and appreciate Gadre et al2 response for contributing to this important discourse. We agree that provider awareness of Islam and expressions of modesty, such as hijab, are crucial to cultural-sensitive care.1 We also agree that Muslim individuals should not be treated as a monolith, and each may have unique preferences about modesty in clinical settings.2 Taking these responses collectively, we advocate for the use of a trauma-informed care lens when approaching dermatological examinations for all patients. Full-Text PDF