Domestic Abuse

I would say one of the most difficult experiences in my medical school experience was during one specific “standardized patient” interview. We have actors come into our small group sessions to simulate the patient-student interaction. I had made it through most of the year with fairly straightforward interviews: throat pain, chest pain, and making a dietary log for a diabetic patient. But, all good things must come to an end. The assignment for the week stated the patient was “a middle-aged woman comes in with a chief complaint of a headache.” Based on the accompanied readings, the entire class knew that the patient had suffered some form of abuse. As the day approached, my apprehension grew.

Studying could not help my situation. I had almost no way to prepare. Listening to lectures and reading my notes can give me all the answers to a test. No readings had the answer for this trial I was about to face. Talking to similar patients may help, but every case is unique. You have to show the patient empathy but all you can muster is sympathy. This is something I hope never to live through but I want to be there for the patient. I just had to face this patient head on. My plan was to conduct a normal interview and focus on the headache. If any troublesome information came up, I would pursue it.

The woman walks in wearing sunglasses covering half of her face. I instantly knew she was hiding a black eye behind those shades. What I didn’t expect was for her to take off those sunglasses and reveal the gigantic black eye covering over 25% of her face, it seemed. Now I was forced to stare directly into her eyes and NOT talk about the black eye until the end of the interview. You must build a bond with the patient, the black eye will be there at the end of the interview whether I address it now or later. I proceeded with the interview. The patient told me about getting into a car accident and hurting her head. The rest of the interview was pretty standard. When I asked her about her home life and if her and her husband argued, she didn’t seemed to have any concerns. As the interview drew to a close, I came back to questioning about her husband. Careful probing lead to her breakdown and confessions about the abuse. I didn’t ask for specific details, I had the information I needed. Before I knew it, I was centimeters away from the patient and fighting my sympathetic tears. I conducted the remainder of the interview the only way I knew how, I offered the patient comfort and security in this safe space. She left knowing that I could be reached whenever she needed anything. The doctor observing the interviewed praised my interviewing skills but said, eventually, the sympathy will fade. If there is anything I want to learn during medical school, it is how to retain my sympathy AND be a doctor to patients.