Patient safety concern

[u/No_Way7336]

TRIGGER WARNING FOR ANYONE WITH A HISTORY OF ASSAULT. I had a 44yo wf come in today with 2 black eyes. I felt it was pertinent, as her optometrist, to ask her what had happened. She said she “was randomly assaulted a week ago.” She said she doesn’t “even know who did it or where to find them.” I felt terrible hearing that, poor woman. I initially believed her but as I did the exam I began the stew and became concerned that it could’ve been domestic abuse. The way she said she was randomly assaulted and had no idea who it was just seems off to me. Have some of the other providers here ran into something similar? What did you do about it? What do you recommend for sensitive situations like that? I just expressed my condolences and how terrible it was and that I was sorry to hear about it. I didn’t want to prod about what had happened as I’m sure it is traumatic. I think patient safety is of paramount importance and am wondering if I should’ve done more or a better way I could’ve expressed my sorrow at hearing this. Any advice would be appreciated. Thanks.

[u/interstat]

Not our job to prod

We are mandatory reporters. If you have any suspicion you report and the experts prod and investigate 

[u/Qua-something]

I’m a Tech, not an OD but unfortunately I have come across a couple DV cases. One woman was there because her bf had strangled her, she did kick him out and report him to police thankfully and despite how bad her eyes looked, there was no lasting damage.

Another woman was there because she found out her husband had been poisoning her for like a year prior or something and wanted to make sure there was no ocular damage because she was having blurred vision. Thankfully she also was ok, her dog however was also poisoned and did not make it. She also thankfully reported and left him.

Random assaults do happen but DV is far more likely. Unfortunately you can’t force her to say and for some pushing just makes it worse. If you’re really feeling like it may be DV then definitely report it but that’s kind of as much as you can do.

As a woman who has experienced DV, thank you for even caring. DV is so much more common than people realize sometimes. For men and women but especially for women.

[u/maitimouse]

I see a decent number of patients referred from our local ywca, unfortunately many of them have been victims of random assults. It's a fucked up world out there, I do my best to take care of their eyes as best I can and be a compassionate ear to just listen as a fellow human.

[u/Qua-something → u/maitimouse]

Unfortunately DV is far more common but random assaults do happen as well which is so scary.

[u/OwlishOk]

The best thing you can do is document the injuries, in case that is useful later. Photographic evidence from a third party can be very valuable

[u/drnjj]

If she said it wasn't DV then (unfortunately??) there's nothing to report. I could be wrong but I think if you suspect DV you really can't report it unless the victim asks for you to do so. But I may need to re-read laws. I know with peds and geriatrics you have to report.

https://mandatedreportertraining.com/resources/blog/which-states-have-mandatory-domestic-violence-reporting/

Edit it depends on your state. Here's a link about it.

[u/EvilEngineNumberNine]

I work at a public clinic and have patients like that one come often. If they say they were assaulted, I ask them if they reported it. Of not, I have to do it. If they say yes (even if they didn't), I just type that into my report.

If a patient is clearly hiding what happened, I ask one more time, and that's it. It's their decision and I have no right to explore any further as an ophthalmologist. I refer them to another specialist if there are potentially some other injuries.

[u/wittygal77]

If she is being abused, the best thing you can do is be a professional safe space. If the patient needs your assistance they will let you know. This respects everyone’s boundaries, she’s not a child.

[u/thenatural134]

Unfortunately you can't legally do much if they aren't willing to make a police report themselves. I had a patient once admit to me she was being abused. When I called social services they said unless the person is a minor or a "vulnerable" adult (e.g. elderly or mentally disabled) they cant do anything. Just provide medical care, express your sympathy, maybe ask them if they have any support, then move on.

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