Sunday, June 4, 2017

Are You A Victim of Abuse or Neglect?

Words matter.  Patients can get spooked by the words we use.  All of us have heard vignettes of how some inadvertent harsh words from a physician have caused injury.  I know there were times that I wish I could rewind and erase some errant words. 

Sometimes, an innocent remark from the doctor doesn’t land innocently.   When I ask as a matter of routine, ‘is there a family history of colon cancer’, as I do with every patient, this may provoke anxiety in a patient who is seeing me for a bowel disturbance.

Words Matter

We ask every patient who arrives at our ambulatory surgery center if they have a living will.  This often causes the patient to utter a nervous joke.  We then go on to ask if the patient has ever been ‘a victim of abuse or neglect’.   We are required to ask this..  It would seem rather unlikely that a patient who has just purged themselves for the pleasure of a colonoscopy, would confess to a nurse that (s)he is meeting for the first time that (s)he has been victimized.  Keep in mind that this a question follows a barrage of very routine medical inquiries.
  • Did you complete the laxative prep?
  • When did you last eat or drink?
  • Did you take any medications this morning?
  • Have you ever been a victim of abuse or neglect?
  • Who will be driving you home after the procedure?
Let me state unequivocally, that I am dead against all forms of abuse and neglect, both foreign and domestic.  I acknowledge that this is a serious problem that is clearly under-reported, particularly among the elderly.  I am skeptical, however, that querying our patients who are poised for an endoscopic adventure about a personal abuse history is likely to be enlightening.  A better case could be made for having these conversations in our office practices after we have developed rapport.

Who makes up these silly rules?   This is but one example of the documentation abuse that has been foisted upon the medical profession by the government and others.  I wish we could simply neglect to comply, but this boldness would only generate more government abuse on us.  

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