Sometimes I hate people

[roja]

I started off my night last night with extreme drama queens with muscle pain. several of them. No big deal, I tend to treat it like a duck in water or whatever that statement is.


And my last case of the night was a 24 yo African muslim woman who came in to be treated for vaginal d/c for the third time in a month.... because your husband refused to come in and get treated and kept forcing her to have sex with him, daily. She had no family, no friends and was fearful of trying to physically stop him for fear of physical abuse.

Even though she told him to stop, that it hurt, that she was crying, that she had NOTES from the ED saying to come in, he continued to force her to have sex with him.

We had no DV advocate and she didn't want to press charges because she has two small children. It was one of the rare times I gave out my card with my personal office number.

I thnk i would have done bodily harm to this guy if I had seen him.

/soapbox.

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[EvoDevo]

What kind of animal does this to a person???

Let me know if you need someone knee-capped.

 

[southerndoc]

And my last case of the night was a 24 yo African muslim woman who came in to be treated for vaginal d/c for the third time in a month.... because your husband refused to come in and get treated and kept forcing her to have sex with him, daily. She had no family, no friends and was fearful of trying to physically stop him for fear of physical abuse.

Even if your state doesn't have reporting laws for domestic violence, almost every state has a reporting law for STD's. If you're state has such a law, and if you reported it, the husband will get a visit from the health department.

I feel for the woman though. I wish she had enough courage to leave him.

 

[hyperbaric]

Is adult protective services an option in this situation?

 

[Miami_med]

Even if your state doesn't have reporting laws for domestic violence, almost every state has a reporting law for STD's. If you're state has such a law, and if you reported it, the husband will get a visit from the health department.

I feel for the woman though. I wish she had enough courage to leave him.

With a woman in this situation, one visit from the health department to the husband may equal the last time that she is "allowed" to come get treatment.

Oh yeah, and you only hate people sometimes?

 

[moonshade13]

all I can say is wow hope she gets help soon

and the more I work with people the more I say I hate people all kinds of people that is why I like working in the file room of medical imaging less people to deal with face to face.

As I say all the time my hat is off to all of you.

 

[howelljolly]

Im just a med student, and I dont know a blinkin' thing about regional laws, but I'd persue the Dept of Health angle.

I had a patient on a rotation, who we had to see because the DoH paid them a visit. They had to drag them in, kicking and screaming. They were also "non-complaint" with treatment for STD

I felt a lot better after that.... and I ALWAYS hate people.

 

[roja]

That visceral feeling seems great but there is a complex social system at play here that requires a finer tool, unfortunately.


The last thing you want to do is put this woman into a situation where she is even more isolated.

 

[Wackie]

Man, that sucks.

If social work gets involved are they required to report it or can they limit things to only give her resources to help her leave that "person"? Like a women's shelter or something?

 

[howelljolly]

I see your point.

Even though with the STD might be cured by involving the DoH, that could easily make things even worse for her at home.

I didnt think of it that way. Its a tough call.

And that, my friend, is why I HATE people.

 

[howelljolly]

Man, that sucks.

If social work gets involved are they required to report it or can they limit things to only give her resources to help her leave that "person"? Like a women's shelter or something?

I got money that says a womens shelter won't make her life any better. Psychology is a funny thing. Even if you take her out of that situation entirely, she might always feel that she failed at her marriage.

 

[pingouin]

If social work gets involved are they required to report it or can they limit things to only give her resources to help her leave that "person"? Like a women's shelter or something?

ED social worker here, although I work in the peds ED so I don't run into this quite as much.

If the DV victim (not always a woman) does not want to press charges, then there is no agency who would take this report. Child protective services stops caring on the 18th birthday (and honestly- successfully reporting abuse of a 17 y/o is pretty hard sometimes). Adult protective services is typically reserved for the elderly and disabled (mentally or physically).

Many larger hospitals have a DV advocacy program like roja alluded to- always a good idea to try to get them to come down if you can. If not, see if there's a way to have them follow up with the patient at a later time- ask about a time when the perp may be at work, or if a friend/neighbor/family member has a phone the victim might use. Safety is key, as a perp will take it out yet again - maybe escalating- on the victim if s/he gets angry.

Cultural and religious beliefs must be taken into account, as well as available resources- especially in this case, being an immigrant family. Are women considered to be subservient in this family's culture? Does she have access to money? A phone? Do they have family/friends in this country? Or is she isolated and cares for the children alone? Are there language barriers to getting assistance? Is she legal? If not- that would exclude her from many resources. I could go on and on and on.. Is there any sort of International Institute serving this family's cultural background? That might help.. Social work would know about that.

One thing to consider, if she ever brings the kids in, is to look them over for any signs of trauma. THAT would warrant a call to child protection if there were no adequate explanation or if they disclosed something. I suppose we could kick around the idea of emotional abuse via the children witnessing their mother's abuse, but that may not fly with the hotline. Plus, if you were going to take this tactic, you'd want enough proof to warrant child protection getting both kids AND the mother to a safe place. If they just say "we'll go to the house tomorrow, they can go home", that would *not* be a good scene.

 

[southerndoc]

I see your point.

Even though with the STD might be cured by involving the DoH, that could easily make things even worse for her at home.

I didnt think of it that way. Its a tough call.

And that, my friend, is why I HATE people.

The difference being not all states have domestic violence reporting laws, but all states do have STD reporting laws. Fail to report one, and you could easily lose your license.

 

[bartleby]

Typically, the lab will file the initial report with the dept. of public health when the PCR probe comes back for GC or chlamydia, for example. There is a secondary reporting form that has to be filled out about whether or not the person has been treated. This naturally varies state by state, but it isn't as if you have a form to fill out every time you see somebody with a non STD-proven discharge.

The difference being not all states have domestic violence reporting laws, but all states do have STD reporting laws. Fail to report one, and you could easily lose your license.

 

[southerndoc]

Typically, the lab will file the initial report with the dept. of public health when the PCR probe comes back for GC or chlamydia, for example. There is a secondary reporting form that has to be filled out about whether or not the person has been treated. This naturally varies state by state, but it isn't as if you have a form to fill out every time you see somebody with a non STD-proven discharge.

As you mentioned, it varies by state. In Connecticut, a physician can and will lose his or her license if he or she fails to report an STD. This not only applies to patient's with PCR-diagnosed GC, but also those suspected enough that you treat prior to confirmatory studies. Yes, physicians are required to report probable cases here.

The rule here is that every patient that gets treated must be reported, whether confirmed or not.

 

[anothertbmember]

you could deal with this "unethically" by prescribing the wife 2 courses and telling her "with this amount, if you need to you could completely treat the disease again, maybe even on someone else ." But that's just a ridiculous idea from a med student. Of course you have to hope there are no allergies...