Health Screening Means Asking Tough Questions
Submitted by Dr. Gwenn Is In
This article from the NYT yesterday raises some important health screening issues. The headline actually says it all: “Doctors can play crucial role in cases of domestic violence.”
While it sounds like common sense and perhaps a bit obvious, the truth is too many doctors don’t ask the tough questions. Part of the issue is time. The typical office visit doesn’t allow for much time to do more than address the question at hand. The other issue is comfort level. Many physicians are uncomfortable or uncertain about how to raise these very difficult and sensitive issues and many patients are scarred and unsure how to discuss the violence in their lives.
But, part of the issue are assumptions that if a woman looks fine, she is fine. And, perhaps assumptions that domestic violence only occurs to “certain people”. What people and physicians have to realize is this is a problem that crosses all socio-economic lines. Looking well put together doesn’t mean there isn’t some horrible secret being kept. Trying to act like everything is ok doesn’t mean that everything is ok. And, if doctors see bruises and other physical signs of something wrong, it is definitely not ok to not ask about those bruises in whoever the bruises are on regardless of their profession or bank account.
Asking about domestic violence is the only way to help women in trouble find a safe haven and help her get help. But, it won’t happen in one visit or by asking just once. As Dr. Nicolaidis said to the NYT:
“The reasons to ask…are to educate a patient and to open the door so that the patient knows she can come to you. It’s part of developing a real relationship with your patient. Over time, you might be able to uncover the abuse and improve her safety, but you also might better understand why she’s having her symptoms and how to better approach her self-management of her illness.”
So, we have some work to do in the healthcare system and have to learn to better address these tough issues. And, it can’t just fall on internists or Ob/Gyns. Pediatricians see moms all the time, yet how often do we ask them about their safety? As part of caring for a family, we need to find better ways for really asking about family health and safety of family members is a gigantic part of that. To cover any ground, the first step is to shed the assumption that if a situation looks ok, it is ok.
It won’t be easy to figure out how to ask these tough questions, but we owe it to the families we care for to find a way.
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