April 20, 2011

the role of a physician is NOT

The past few days have been focused on many issues that mainly affect women - obviously this interests me a lot, both because I am a woman and because I'm interested in women's health. I reviewed pelvic exams yesterday and breast exams today, talked about prenatal care and the changes that happen during pregnancy, then learned how to do an endometriol biopsy and place an IUD, talked all about contraception, then had the afternoon to discuss intimate partner violence. The afternoon was challenging, so I thought I'd share some tips.

The first is that a statement of confidentiality - that the doctors office is confidential, that nothing will be said to your partner without your permission - is very powerful. This seems to most naturally fit in right before I start to ask questions about alcohol, drugs, sex life. Just a simple "I ask everyone these questions and I just want you to know that..." And before asking specifically if the person feels safe saying "Because violence is so common, I try to ask everyone about it every time".

The second is that the role of a physician is NOT many things that any person would instinctively want to do (especially one who is spending so much time on a career path to solving problems and helping people).

Namely, the role of a physician is NOT:
to end the abuse,
to make the person leave their abuser,
to solve the victims problems nor is it
to provide lengthy counseling

I think that would have been more difficult for me to accept if I had not just had my psych rotation. But now I am beginning to understand that much of medicine is about giving someone the option to make their own choices. It can be more dangerous to try to get someone to leave their abuser or to confront the abuser or to call the police than it is to wait until the person who has being abused has decided what they want to do.

The role of a physician DOES include:
asking people about intimate partner violence
telling the person it's not their fault
telling the person that no one deserves to be treated like that
providing resources that the patient could use
including an emergency 24 hour hotline
continuously assessing the person for escalations in violence
helping the person get help in whatever way they want it


(I'm not sure this totally fits, but it kept running through my head this afternoon: )

"will I lose my dignity, will someone care
will I wake tomorrow from this nightmare?
there's only now, there's only here
give into love, or live in fear
no other path, no other way
no day but today"

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