Sep 8, 2009

Doctors and Abuse

An email follow-up question from the Review Of Systems post:

I don't understand why they ask, "Have you ever experienced physical/verbal abuse?" This doesn't have anything to do with establishing a diagnoses. What's the point?
Doctor D doesn't enjoy asking prying personal questions. It makes everyone uncomfortable, but this is a question that doctors should be asking more often.

Medical professionals do a terrible job identifying people in danger from family violence. Statistics show that people who seek more medical attention have higher rates of abuse than the general population. A study found 1 in 3 females who visit emergency rooms have been recently abused. Doctors usually just don't find out. We may do a great job protecting someone from Hypertension, while the biggest threat to their health is the person with whom they live. Doctor D knows he has missed opportunities to help patients in dangerous situations. Sometimes simply discussing abuse can be a step towards connecting to resources that save lives.

Because doctors do such a crappy job at this, we are frequently reminded to ask everyone about domestic violence. Doctor D must admit, he is still pitiful at broaching these questions. It makes people uncomfortable when doctors ask, and doctoring is already an uncomfortable job. You expect us to be friendly and trustworthy while asking about how much you really drink and sticking our fingers in your orifices. It makes for awkward interactions!

Asking such questions in a trusting doctor-patient relationship can be very useful, and usually a patient will understand the doctor has good motives. The reader who emailed Doctor D was asked on a paper questionnaire. Sounds like the doctor was trying to follow the recommendation to ask while avoiding the awkward conversation. Unfortunately it shifted all the awkwardness to the patient and also confused her. I also imagine the paper-based format won't uncover many cases of abuse, because patients may hesitate to disclose this on a form.

I think this reader's doctor had good motives, just an ineffective approach. Doctor D personally apologizes for doctors. We all do a lousy job at discussing these sensitive topics. It is harder than you think. Please be patient with our fumbling attempts at difficult questions.

A question for you:
What is the most uncomfortable question a doctor every asked you? How did you respond? You can comment here or
e-mail Doctor D.


Anonymous said...

What happens when the abuse was at the hands of a doctor?

Anonymous said...

Awkward? Once had a doctor ask how I knew the exact date I got pregnant. The way he phrased the question made it a little easier, something like, "Not to get too personal, but how do you know?" I blushed, stammered, and said that with a houseful of toddlers who crawled into my bed at night, we just didn't get that many opportunities.

Anonymous said...

"That's a lot of broken bones! Were you a tomboy?"

"Ummm. Why do you ask?"

Helen said...

"Are you even IN a monogamous relationship?" back when you had to see a doctor to get Plan B. I told him I was, and then he said it didn't matter anyway, because he didn't agree with it and wasn't going to give it to me. Which was his prerogative, except that his nurse had made me wait for 3 hours knowing he was going to say no.

Anonymous said...

Ahh sometimes it can get sticky. Explaining why we need to know or putting things in context gets me by most of the time. I can often fall back on "I have to be really thorough, because I'm less experienced." Also, with young people, reminding them of our confidential relationship and the few exceptions can open the door to talking about things they never want to leave the room.

Abuse can come from doctors, too, and sometimes a sensitive situation can be made worse by how the doc handles it. I know once as a patient, I felt put in a really awful state simply because an interaction wasn't handled with tact or consideration for how it might effect me. Though it wasn't a big deal in the end, it reminded me that we've got to do our best not to skim over the "little things" when body language and other clues suggest they are not little at all for that person.

This is a bit of an aside, but there's a big stink in the Canadian media about a general surgeon who got his licenced revoked in Arizona and then was allowed to practice no problemo in our fair province (BC). While there are competency concerns, the thing all his disgruntled patients focus on in interviews is the way they felt treated. Yah, we mess up, but half the battle is preparing people for common complications and treating them with respect and sincerity. The majority of complaints to the college are not for malpractice, but rather for poor encounters secondary to crappy communication skills.

Anonymous said...

I lived for a number of years in an abusive family situation - my teenage stepchild was abusive toward me. I always answered the abuse screening questions honestly and never got so much as a resource suggestion.

Doctor D said...

Thanks for all the interesting stories. We doctors really have a lot to learn.

I really hope that although we aren't great at discussing this subject most doctors would still treat you with respect even if the abuse came from a doctor. I don't think many of us would have any sympathy for an abuser just because they were a doctor.

Another real problem with questionnaires is does anyone really read them? Often they are just briefly skimmed over and important things get missed. Sounds like the anonymous commenter this morning got let down by the system even while asking for help. That is really sad.


Oh god I so couldn't resist answering this one.
While having a procedure done and the urine was reluxing up into my kidneys and hurting like god only knows what Dr Facetious say's scathingly, "oh come on, You have been through far worse than this in your life" yes she knew I had a Domestic issue in the very past. Nice one Dr Facetious.
People may hesitate to speak of their issues with their Doctor because, if things go wrong they don't want their past used as excuse for the Doctor to get away with their little(major) mistake.

Moose said...

I gotta respond -- I put a twist on this. I used to go to a clinic that was part of a hospital's family practice residency program. Every 3 years I'd get to break in a new doctor, which for a while was kinda fun. The best was when they'd start asking about sex. Most were still new enough that you could tell they weren't yet used to asking strangers about such things. So when they'd ask me if I had a sexual partner I'd look down at one of my hands, then lift it and wave at them.

Never failed, they always blushed deep red.

Post a Comment