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.

Review Of Systems

A question sent to Doctor D:

"Why do doctors ask for information that has nothing to do with what I'll be seen about?"

Doctor D asks his patients superfluous questions all the time. You come to Doctor D with ankle pain and next thing you know you are answering questions about your breathing, how much alcohol you drink, if you have fevers, and your sex life. Doctor D asks these questions because he is nosy.

Doctors are nosy, but the more pertinent reason we must ask those questions is because we are lazy. Doctors, like most people, have a nasty habit of jumping to conclusions before thinking carefully. To combat mental laziness the MD powers-that-be came up with the "Review of Systems" where doctors ask a whole lot of questions about your body that don't directly relate to what's bothering you. It forces your doctor to think outside the box. Usually it turns out to be the obvious diagnosis, but the Review of Systems helps your doctor recognize when it isn't.

Doctors also do this because we are greedy: insurance won't pay for your exam unless at least some Review of Systems is done. Fortunately this is one of those situations where your insurance company actually does something for your benefit. They know a Review of Systems is cheaper than a CT Scan.

When you come to Doctor D with a swollen ankle without any injury it is probably gout. But questions about your breathing or your genitals force Doctor D to at least consider that non-traumatic ankle swelling can be caused by a blood clot or a gonorrhea infection.

So now you'll know why we ask all those crazy questions.