Thursday, May 12, 2016

Step 2 CS: Domestic violence

Hey everyone!

I talk about approach to a patient with domestic violence in the video. I also stress on how to counsel.



These are some points from the PowerPoint Slide.

How do they present?
Multiple injuries (Fractures, bruises) over a period of time.
Non specific pain that points to no diagnoses, patient comes repeatedly to the doctor for attention.

What will the patient tell you?
I slipped and fell.
I don’t know how I got that bruise.
I am very clumpsy.

How to get them to open up?
You say you are clumpsy but your injuries concern me. Is there something else that you would like to share?
How are things at home? Who do you live with? How is your relationship with him?
I see many patients in my clinic who have problems that are similar to yours, I can help you if you tell me about it.

Confidentiality
I know it’s hard for you to open up to a stranger, but consider me as a friend. I will assure you everything you tell me will remain confidential.
If kids: Everything you tell me will remain confidential… Unless I have reason to believe that the children are being harmed. In that case, I will have to report but it’s up to you whether you want to share it with me.

When the patient starts opening up

It’s my boyfriend…
He gets really stressed at work / he drinks a lot.
He yells, calls me names…

What about your boyfriend?
What does he do when he gets stressed / drunk?
Does he hurt you?

When in denial (Justifies abuse)
It’s all my fault.
But he loves me.
He is so stressed.

Even if it is your fault, you don’t deserve to be treated this way.
People who love you shouldn’t hurt you.
It’s not okay for him to take out his stress on you.

Transition to counselling
Do you know, over time, these incidents tend to increase? It is good to have a back up plan if they increase to a point you are unable to handle / you decide that you can not tolerate his behavior anymore.
Do you have a place to go?
Do your friends and family know about it?

Counsel about back up plan
Hide some cash, clothes, documents in a go bag so you can grab it and leave.
Keep your friends and family informed about the situation at home.
We have a social worker that can help you find a place to live if you have no where to go.

Counsel more
Is it safe for you to go home today?
You can always call me, if you feel uncomfortable calling me, you can call a helpline which is available 24x7 and is completely confidential. I will put the number in your discharge papers today.
You can also call 911

Examination
Examine the bruised area / fracture.
X-rays, etc.

Closure
It was very brave of you to open up to me today. Know that you can do it next time as well. Take care of yourself, okay?

Don'ts
Do not be judgmental. (Don't make her feel she is stupid for staying in an abusive relationship.)
Do not be direct while asking questions – Does he beat you? Did he push you off the stairs?
Do not tell the patient what to do (Leave your husband, call the cops.) Your job is to advice.
Avoid using words like victim, abuse, violence.

Extras
Screen for depression: SIGECAPS
How are you handling this? Do you have thoughts about hurting yourself?
Are there any guns at home?

That’s all!
Let me know if that was helpful :)
Practice, practice, practice!
Use simple words.
Be confident and empathetic.
Stay awesome and good luck for the exam!

-IkaN

PS: SAFE GUARDS is a dumb mnemonic. Do not ask questions back to back using the mnemonic just for the heck of it and disregard what the patient is feeling.

If you want to download the PowerPoint or want the slides, email me at medicowesome@gmail.com, I'll send them to you.

2 comments:

  1. Hello, first of all thank you IkaN for Medicowesome. It is a really awesome blog for students like me. All your posts are really interesting and makes one want to read more. Will be eagerly waiting for your next post!

    ReplyDelete

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