Question 1

September 9, 2015

Question:

Please read the following case and answer questions 1 & 2.

A 22 year-old new patient in your practice checks boxes on the "New Patient Health History" questionnaire that indicate that she is being physically and sexually abused by her partner. Your schedule is full for the day and this is the first time you have ever had a patient disclose being in an abusive relationship on your practice's health history form.

Further history reveals that the abuse has been going on for three years and is gradually escalating. She is not certain if she is in significant physical danger at the present time although she does say that she has definitely felt unsafe at times in the past few weeks and finds herself constantly "walking on eggshells." She states that she feels her self-esteem eroding and has been starting to have panic attacks while driving.

Question 1: Based on the history provided, what is the most appropriate action step at this time? [select the one best answer>

Answers

Answer:

Advise the patient to leave the relationship.

Correct Answer?

Explanation:

A. Incorrect The health care provider's job is to provide the patient with options, support, and resource and referral information in a manner that is trauma-informed, culturally-aware, and non-judgmental. The patient is the one who should be empowered to decide if and when she or he may be physically, emotionally, and logistically ready to leave. Advising a patient to leave a relationship before the patient is fully ready and prepared can place the patient in increased danger.

Answers

Answer:

Refer the patient and her partner for couples counseling.

Correct Answer?

Explanation:

B. Incorrect Marriage or couples counseling can be dangerous if coercion or violence is present in a relationship. In this circumstance, the focus of attention should be on the perpetrator's behavior in the context of participating in a certified batterer intervention program, rather than on marital therapy geared to identifying and coming to agreement about how to fix problems in the relationship . If a relationship is coercive in nature, couples counseling affords the abuser a platform to voice complaints and, as a corollary, requires the survivor to make efforts to "improve" the relationship, leaving the survivor unable to speak freely without creating the risk of increased harm once the session concludes.

Answers

Answer:

Assess the patient’s immediate safety.

Correct Answer?

Explanation:

C. CORRECT Once a disclosure of abuse is made, the health care provider should perform a focused danger assessment, evaluating the patient's level of fear and needs for immediate safety measures. Indicators of imminent danger include an increase in frequency or severity of violent acts on the part of the perpetrator (including sexually violent behaviors), threats of homicide or suicide by the perpetrator, the presence or availability of a firearm or other lethal weapon, and new or increasingly violent behavior outside of the relationship on the part of the perpetrator. If there is little risk of imminent danger, supporting and validating statements can be offered and a follow up visit can be scheduled to focus exclusively on gaining a greater understanding of the history of abuse, understanding the health effects that may be present, and connecting the patient with expert community-based resources.

Answers

Answer:

Ask to meet with the patient’s partner before deciding on the best course of action.

Correct Answer?

Explanation:

D. Incorrect The health care provider's relationship is solely with the patient. Even if the partner is also a patient, each relationship must be kept independent, private and confidential. Discussing anything about a patient with a partner or with anyone except a clinician involved in the patient's care without first obtaining the patient's freely provided written consent is a violation of numerous patient privacy regulations including HIPPA. In addition, discussing any aspect of an abusive relationship with the perpetrator can place the patient in potentially grave danger and is strongly contraindicated.

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