This post is mostly for people who are health care or social workers. Two Mondays ago I listened to a great lecture about screening for domestic violence, and I've been meaning to blog about it since. The highlights of the lecture were two very important points, one of which I had considered before and one of which I hadn't. The first point was that nobody minds being asked by a health care professional if they feel safe when they're with their partner. I ask this question at least twice a day at clinical, and not once has anyone had a problem with it. Moreover, the presenter on Monday had run with a study in partnership with Mailman, Columbia's school of public health, which had corroborated my experience. People just don't mind. That said, I am sure one day I will offend one patient by asking. And on that day, I will be able to tell him/her, "I ask everyone." I am equally sure that one day when I ask this question, one of my patients will say, "No, I don't feel safe."
Honestly, I don't feel prepared for that moment. I don't feel like I'll know the right way to respond, and I'm concerned that if that is the first time my patient has told anyone about his/her situation, me screwing it up will have consequences. And this was where the second important point came up. When you ask someone if they feel safe, you're screening. Your goal is not to fix the situation by asking this question any more than it is to cure HPV by doing a pap smear. You're detecting the problem so the person can get help from someone who has more experience and more training. Once you've listened what the person has to say (obviously key), the presenter urged us to say something like, "What you are telling me is very important, and, if you are willing, I want you to share it with someone with a lot of experience with this kind of thing." And then give them a damn good referral, preferably in person. Like, walk them down the hall to the appropriate office. If that is not an option (private practice, social worker out that day) leave a message for the worker involved and ask the patient to schedule a follow up with you ASAP.
This ideas were really helpful for me, since I am obviously not a trained counselor, but am someone who wants my screenings to go somewhere. If anyone has any experience with this, please let me and other readers know via comments.
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Sounds like you already have a good idea of what to do, although it doesn't happen as often as you'd think in a busy healthcare environment: if you don't know, find someone who does. It's so simple and yet I've seen it not happen so often.
ReplyDeleteI did have one thought about the statement that no one cares about being asked about domestic violence. I'm no social worker, but I would expect that some people who do react negatively or defensively to being asked may be the very individuals who are experiencing domestic violence and reacting out of a need for defense.