drk1980
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A 24-year-old woman comes to the office for an initial prenatal visit. A home pregnancy test was positive 2 weeks ago. Her last menstrual period was 10 weeks ago. She has been healthy and has no significant medical history. She takes no medications. During the interview she becomes tearful and says, "My husband hit me several times 6 weeks ago and I'm afraid that it may happen again. He's become very loving now since he found out about the baby, but I'm still worried." Vital signs now are: temperature 36.9°C (98.4°F), pulse 80/min, respirations 20/min and blood pressure 110/70 mm Hg. Pelvic examination shows a 10-week size uterus and is otherwise normal. Ultrasonography confirms a 10-week gestation. Which of the following strategies is most appropriate?
1 Provide her with the name and phone number of a shelter for battered women
2 Reassure the patient that abusive behavior is less likely now that she is pregnant
3 Recommend marital counseling
4 Schedue an appointment with the husband to discuss his abusive behavior
5 Tell her that you will report this to the police if it happens again
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| star1
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we know that spouse abuse in not mandatory reportable but here fetus life is at risk
so what seem to be the correct answer?
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| Justice
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star1 wrote:
we know that spouse abuse in not mandatory reportable but here fetus life is at risk
so what seem to be the correct answer?
Didn't know about that
I would definitely go with (1)
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| silenced, M.D.
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Option #1
Better would be counsel her to report it, but if she doesn´t want to right now, then give her a phone number where she could ask for help when she needs it.
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| doc_clotaire
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agree with # 1
it seems more apropriate
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| kelash kumar
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it looks some what different scenerio. i gues its 1.
drk can u tell the right answer
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| neo335
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how about the 4th option?
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| vradojc1
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You should never confront abuser!
1 is the only one that makes sense.
From UpToDate:
Mandatory reporting — The physician needs to be aware of situations requiring mandatory reporting. Domestic violence involving a child has to be reported if the following criteria are met: the child is under the age of 18; the child is suffering as a result of abuse; or the child has witnessed his/her mother being abused. The report must be made to the local Department of Social Services. Abuse of disabled persons must be reported to the Disabled Persons Protection Commission. Elder abuse, which is defined as abuse of patients age 60 or older, must be reported to the physician's local Elder Abuse Hotline.
Most states do not currently require mandatory reporting of domestic violence against competent adult women. California, Colorado, Kentucky, Mississippi, Ohio, and Rhode Island are exceptions; mandatory domestic violence reporting laws in those states require physicians to report all injuries from domestic violence [67]. A study of 1218 recently abused women presenting to emergency departments found that 44 percent did not support mandatory reporting of domestic violence to police [68].
Edited by vradojc1 on 05/03/07 - 12:57 PM
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| haduytu7
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Why not 3?
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| robin082006
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1
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| DrVirgo
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star1 wrote:
we know that spouse abuse in not mandatory reportable but here fetus life is at risk
so what seem to be the correct answer?
This is not my personal belief... what the boards believe as I have been told by Kaplan is that the wife is your patient, not the fetus.
She is being abused, and it's not mandatory reportable, so all you can do is:
1 Provide her with the name and phone number of a shelter for battered women
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| DrVirgo
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haduytu7 wrote:
Why not 3?
Marital counseling is for people who don't get along and are having trouble with their marriage, NOT for abusive relationships!
Most of the time it is very hard to rationalize with an abuser and get him to stop the abuse. This is not an option here. The woman needs to get help; she may even have to leave the abusive relationship if her life is in danger... so in this case we as doctors need to provide her with information on shelters and other support programs.
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| cirus
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Ill go with 1 too
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| kpmle2
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Was thinking of 3 but will go with option 1.
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| dr in trouble
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1
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| Drtweetie
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agree w/ (1) give her the resources
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| gr8doc
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#1. was actually debating between 1 & 3 but DrVirgo's explanation makes it all clear. Thanks buddy.
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| coolmavs
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yes between 1 & 3, but virgo has made it clear
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| fandarast
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Partner or spousal abuse (Kaplan)
DO: provide emotional support and information about social resources, ensure safety, document injuries carefully and schedule follow-up appointments
DON'T: express doubts about the patient's account, express indignation against the perpetrator, instruct the patient on how and when to leave her husband or partner, refer for marriage counseling, try to persuade the perpetrator to stop abusing
Edited by fandarast on 09/22/07 - 03:35 PM
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