Response to “Ethically Conducting Hair Examinations among Individuals with Hijabs”
Authors: Amina Ziad, Layla Al-Zubi
Journal: Journal of the American Academy of Dermatology (2023)

To the Editor: We commend Abdi et al's1Abdi W. Sow Y.N. Blalock T.W. Ethically conducting hair examinations among individuals with hijabs.J Am Acad Dermatol. 2023; S0190962223009040https://doi.org/10.1016/j.jaad.2023.05.020Abstract Full Text Full Text PDF Scopus (1) Google Scholar article, "Ethically conducting hair examinations among individuals with hijabs," and appreciate Gadre et al2Gadre A. Galaria N. Aguh C. Response to "Ethically Conducting Hair Examinations among Individuals with Hijabs.".J Am Acad Dermatol. 2023; S0190962223024192https://doi.org/10.1016/j.jaad.2023.07.1027Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar 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.1Abdi W. Sow Y.N. Blalock T.W. Ethically conducting hair examinations among individuals with hijabs.J Am Acad Dermatol. 2023; S0190962223009040https://doi.org/10.1016/j.jaad.2023.05.020Abstract Full Text Full Text PDF Scopus (1) Google Scholar We also agree that Muslim individuals should not be treated as a monolith, and each may have unique preferences about modesty in clinical settings.2Gadre A. Galaria N. Aguh C. Response to "Ethically Conducting Hair Examinations among Individuals with Hijabs.".J Am Acad Dermatol. 2023; S0190962223024192https://doi.org/10.1016/j.jaad.2023.07.1027Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Taking these responses collectively, we advocate for the use of a trauma-informed care lens when approaching dermatological examinations for all patients. Trauma-informed care (TIC) is an approach that "integrates trauma-informed practices (acknowledging that potentially traumatic exposures have occurred) throughout a service delivery system."3Substance Abuse and Mental Health Services AdministrationNational Strategy for Trauma-Informed Care Operating Plan.https://www.samhsa.gov/sites/default/files/trauma-informed-care-operating-plan.pdfDate: 2020Date accessed: September 7, 2023Google Scholar This approach creates a safe environment to build trust between patients and clinicians, and it has been successfully applied in various clinical contexts.4Raja S. Hasnain M. Hoersch M. Gove-Yin S. Rajagopalan C. Trauma informed care in medicine: current knowledge and future research directions.Fam Community Health. 2015; 38: 216-226https://doi.org/10.1097/FCH.0000000000000071Crossref PubMed Scopus (242) Google Scholar A pair of TIC lens is a useful framework for approaching the dermatological examination, which can be quite invasive. Using this approach, we avoid ethnic and racial profiling that can perpetuate stereotypes about which patients may or may not have concerns about modesty. It honors and respects patients' boundaries and histories of trauma and gives patients of all faiths and nonreligious individuals control over their care. Examples of practical elements of TIC include the following: asking patients their comfort level with physical examinations, informing patients of all steps involved in examination with opportunity for questions and full or partial examination deferral, offering different options of clothing removal (moving clothes vs changing into gowns), and incorporating trauma history screening questions into patient intake forms.4Raja S. Hasnain M. Hoersch M. Gove-Yin S. Rajagopalan C. Trauma informed care in medicine: current knowledge and future research directions.Fam Community Health. 2015; 38: 216-226https://doi.org/10.1097/FCH.0000000000000071Crossref PubMed Scopus (242) Google Scholar Some patients may be most comfortable with gender-concordant care teams and intake forms, and scheduler scripts should include questions about patients' preferences. It can also be helpful to ask patients whether they prefer the presence of another staff member to serve as chaperone during their examination. Frequently, visibly Muslim women (ie, those who wear hijab) are the center of conversation when it comes to modesty in the clinical setting. However, Islam is only one of many faith traditions that value and practice modesty. Some Muslim women may be comfortable removing hijab and/or clothing for examination, and some may not be—they, like the rest of the populous and regardless of faith background, have varied beliefs about modesty in clinical settings. Applying a TIC approach circumvents assumption-making while allowing clinicians to tailor their examination for patient comfort. This is not to say that acknowledging patients' unique religious, cultural, and racial diversity is not important but rather that a TIC approach will address and meet the diverse needs of populations without the risk of stereotyping or generalizing specific populations. Dermatologists are well-trained, exceptional specialists who take pride in managing complex skin diseases and maintaining high patient satisfaction.5Queen D. Trager M.H. Fan W. Samie F.H. Patient satisfaction of general dermatology providers: a quantitative and qualitative analysis of 38,008 online reviews.JID Innov. 2021; 1100049https://doi.org/10.1016/j.xjidi.2021.100049Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The thoughtful implementation of TIC ensures the best treatment of those with apparent religious or cultural observations of modesty, victims of assault, patients with nonreligious modesty preferences, and those with general discomfort with physicians. The implementation of TIC will ensure that all patients are comfortable during invasive examinations, promote patient autonomy, and build trust with physicians. 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 Ziad et al. for providing a thoughtful and patient-centric perspective on how to ethically conduct hair examinations among individuals who wear hijab.1,2 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. Full-Text PDF