What should you do if your patient is suffering a crisis?
Your favorite patient walks into your office. She has a gruesome purplish-red bruise on her face. She’s avoiding eye contact and ambulating slowly, as if she’s trying to minimize the pain on her left side. She isn’t her usual sunny self, cracking jokes and making fun of everything, including herself. This is worrisome. What do you do? Should you inquire about what’s obviously wrong? Are you thinking that it’s none of your business, so you decide to respect her privacy by not saying anything?
Let’s say you choose not to do anything. You work all day and then go home and live your life. But when you turn on the 11 o’clock news, there’s your patient on the TV. The lead story is that she has been brutally murdered by her husband. How do you feel now? Do you regret not asking the obvious? Are you overwhelmed with guilt?
Now, let’s say the reverse happens. You ask her “Are you ok? You look like you’re in pain. How can I help?” You’re not a social worker, but you are a health care provider. You have a moral-if not ethical-obligation to ask questions. It might save a life. However, most people aren’t comfortable with this. What should you do? You should voice your concerns to your superviser. You don’t have to make a difficult decision by yourself.
Whenever I go to the doctor and they ask “Do you feel safe in your home?” I must stop myself from making a bad joke about it. It’s a serious question that deserves a serious answer. If I had a husband terrorizing me, knowing that someone cares might make all the difference in the world to me.
I attended TEDxOhioStateUniversity in 2018. There was a speaker who had been battered both as a child and an adult in all of her relationships. She was a survivor who went on to complete a Ph.D. and become a professor at OSU. She was a truly powerful speaker who made me stop and think. She illustrated a point about whether we should report domestic violence without the victim’s approval. Why? Because a victim is more at risk to be murdered when he or she tries to leave a marriage/relationship. The humane goal is to help a woman get out of a volatile situation. But the speaker, a survivor, posed whether we should be doing this. She felt we were putting the woman’s life at risk by calling the authorities and reporting it. It also was making the victim remain a victim by not following her wishes.
That made me stop and really give this some thought. The truth is that I don’t know what the right answer is. The purpose of TEDx talks is to get people to think and to talk about important ideas. They succeeded with this presentation. I struggled with this ethical issue for a while. The conclusion that I came to is that there’s a difference between ignoring someone who may be battered and just starting a conversation. I implore you to start that conversation. Take the patient into a private room and close the door. Don’t be rushed. Let him or her know that you’re concerned. Tell them what you see. Don’t be afraid to upset him or her by asking questions; it could save a life.
When I was a rehabilitation hospital social worker, a patient told me she had $3,000 in her wallet. The concern was that it could be stolen quite easily if it didn’t go in the safe. I asked why she was carrying such a large sum of money. She eventually explained how it was her escape money so that she could get away from her abuser. She was afraid if she left it at home, it would be taken. We came up with a plan for her discharge so that she would be safe while convalescing. That gave her great peace of mind. I share this because when you see something that doesn’t feel right, trust your instincts and ask about it. Yes, this is serious. It can be life and death. Don’t be afraid to just start a conversation. You can decide later what you’ll do. Remember that starting a conversation may save a life.
If you do have a patient who walks into the office bruised, you’ll know what to do. Think about this now when there isn’t a crisis. It will help you to be prepared if the situation ever happens.
If you have thoughts on how to handle these difficult issues, email me at email@example.com.