Question 2

Ask the receptionist to reschedule the rest of your patients and apologize to those patients in the waiting room, explaining that you have a patient emergency that must be dealt with.

A. Incorrect   Except in the case of a dire emergency - a truly uncommon occurrence - health care providers can manage their time effectively by incorporating routine inquiry about domestic and sexual violence into the social history. Research has shown that the majority of time, the patient will state that there is no current or past coercion in a relationship. When a patient does disclose, a focused acknowledgment of the issue combined with a rapid assessment of current danger should take no more than a few minutes. In almost all circumstances, a follow-up appointment can be made to focus on the health effects of the abuse that has been identified, and to recommend appropriate community-based expert referrals. Managing time in this way may actually enhance efficiency by validating the patient's statements, build trust and confidence in the health care system, and allow the health care provider to address the underlying issues rather than merely treating symptoms as they arise or recur.

Thank the patient for sharing her situation with you and explain that in the absence of physical injury, the health care system is poorly equipped to deal with problems like this. Provide hotline and other resource information to the patient and instruct her to pursue community-based sources of help.

B. Incorrect   Although community-based resources are key to addressing issues relating to abuse and violence in a comprehensive manner, the health care setting is also an important locus of initial and follow-up care. Sending the patient elsewhere for follow-up care without offering continuity, support, and follow-up from the health care perspective can give a patient the unintended message to "go somewhere else, I'm not interested."

Thank her for disclosing her situation to you, reiterating that you respect her honesty and courage during what must be a most difficult time. Schedule a follow-up appointment dedicated to this particular issue and how it may be affecting her health.

c. CORRECT    Domestic and sexual violence result in numerous and often debilitating health consequences across the lifespan, which merit attention within the health care system. The process of delivering trauma-informed initial as well as follow-up care can be a meaningful therapeutic intervention on its own. Almost every patient ever asked by a health care provider about violence and abuse remembers that encounter as being particularly meaningful and in some cases, pivotal to developing trust in the health care provider, and a turning point in his or her life. When the health care provider states that he or she would like to follow up on this issue, the patient feels valued and is able to perceive that this issue important and appropriate within the context of health care

Refer to psychiatry for evaluation and management of possible panic disorder.

D. Incorrect   Panic attacks are not uncommon in the general population, and are now viewed as a predictable adaptive response to toxic stress associated with being purposely controlled or victimized. The patient can be referred for specialty evaluation and at some point in the future, if need be, but there is no need to make this referral now, until the steps outlined in Choice C have been undertaken.