We started out class with a patient actor who came to us with an injured knee. She was closed off at first but after careful questioning, our classmates were able to slowly get her to tell more about her situation. We learned that certain words can be triggering to a patient in good and bad ways. For example, not every patient who is being "hit, slapped, cursed at, or punched" will believe that they are being abused. Many patients will be in denial stating excuses for their abusers reasons in treating them that way. Therefore, using the word "abuse" with a patient will be too direct when inquiring about their story. Sometimes even asking direct questions such as "does he harm you?" may be too direct. Getting the patient to tell his/her story through continuers and mild questioning will be very helpful when gathering the story for the first time. Always reassure the patient that the person harming them will not find out anything about this conversation. Everything is confidential. Once the patient trusts you as the provider, rapport is built, then stronger, more hard hitting questions such as "does he hit you?" may be asked. Over time the patient may need a few visits with you in order to feel comfortable enough to open up about these situations. Some patients may never feel comfortable enough with you to open up and talk about these situations, every provider yields a different persona and some patients may resonate with you or may not. They can always see a different provider, but then rapport has to be built again and it may delay progress in their situation. In cases of DV, every step needs to be taken at the right time and resources should be utilized at the right time. In an emergent situation a SANE (sexual assault nurse examiner) may be needed for those types of delicate situations and every hospital will have contact information for those services if needed.
Chart carefully and thoroughly after seeing a patient like this. Offer help services, more visits to the doctor's office, counselor or friends. When offering help services to a patient who admitted being harmed or abused, beware of giving pamphlets of information as the abuser may find it and get defensive. A suggestion would be to add a hot line or local domestic violence shelter's phone number to a friend's contact. That way, if the abuser checks her phone, he will think she was just talking to a friend instead of what she is really doing, calling for help.
Below is a link to one of our local domestic violence center that offers shelter, counseling, outreach, advocacy, and case management to its patients. Check out their website and see what places like this can offer patients. As providers we do not have to fix every situation alone, we need to know how to use services like Equinox, work collaboratively with them to get a patient feeling better physically and mentally.