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Example consultation with case finding

Marc calls Zara into the consultation room.
2.9
MARC: Zara!
5.1
MARC: Come in and take a seat!
7.5
MARC: It’s good to see you again, Zara. What brings you here today
11.2
ZARA: I’ve just come for a sexual health test today. I’m worried that I might have something called chlamydia?
20.5
MARC: Okay, yes we can do that today. Why are you worried that you might have chlamydia?
25.8
ZARA: Well, I was going through my boyfriend’s phone and I saw this text message which said something about chlamydia. I was so shocked that I didn’t read the whole message, but I think that he might have slept with someone else and got it.
43.8
MARC: Okay, I understand. When did you see this message? And have you been able to talk to him about it?
50
ZARA: I saw it yesterday. But no, I haven’t been able to talk to him about it. He would go crazy if he knew that I looked at his phone, he does that sometimes, gets really angry if he thinks I’m asking him too many questions about his life. I don’t think I would be able to talk to him about it.
72.3
MARC: How are you feeling? Do you have any symptoms – any pain when passing urine, any discharge, bleeding between periods or things like that?
80.9
ZARA: No, none of that. I get some pain during sex but that’s always been the case since I’ve been with James.
89.4
MARC: Tell me more about your relationship with James, how long have you been together, and are you living together?
95.5
ZARA: Yes we’re living together, we’ve been together for two years now, and are planning on getting married. He really wants to get married, but I’m not sure how I feel.
107
MARC: Why is that? You said that he often gets angry, can you tell me more about that?
112.4
ZARA: He just gets angry with me very easily, especially if I go out with my friends, or go to visit my family, or if I want to do anything that doesn’t involve just me and him. He is always calling me and messaging me, he tells me that he just gets worried about me, doesn’t want anything to happen to me.
135.1
MARC: Are you afraid of him? Has he ever done anything that’s made you feel scared of him?
139
ZARA: Well, not at the beginning, when we were first together he was really lovely, bought me flowers, took me on dates, was really kind and tender. But when we moved in together a year ago, it’s like everything changed. First he just started pushing me when we would argue, but then I feel like he would come home from work and start an argument with me for no reason. I would shout back and then he would punch me, sometimes he would pull my hair, swear at me, and tell me that I was worthless and all sorts of horrible things. I couldn’t fight back as he’s too strong, I would start crying.
187.1
And then afterwards he would console me and tell me he was sorry, that he loves me a lot, and that he just gets angry sometimes because that’s how much he loves me, and would plead with me not to tell anyone, that other people wouldn’t understand. And then everything would seem like it was okay again, until a few days later when the same thing would happen again. But now I’m beginning to think that he will never change, that it will always be like that, and it scares me.
223.5
MARC: Zara, I’m so sorry to hear this, that this is not your fault, and under no circumstance should he be hitting you, it’s wrong, and it’s against the law. You have a right to be safe, and unharmed. Is this is the first time you’ve told anyone?
235.7
ZARA: Yes, it’s really hard because all of my friends are in great relationships, their partners don’t do this to them, part of me feels embarrassed to tell other people, I don’t want them to see him as a bad person, I don’t want them to think badly of me either.
254
MARC: I don’t think they would Zara, I think they would be very concerned for your safety, and be very supportive. Would it be okay if I asked you some more questions?
275.5
MARC: Zara, I’m very worried about you, and I am worried for your safety as James is becoming more violent, and I am worried that something even worse could happen to you in the future. I would like to help you make a plan to keep you safe – what do you think about that?
288.5
ZARA: I don’t know, I don’t know. I don’t think I can do this anymore, I am becoming scared, scared about the next time that he might hurt me. Maybe it would be a good idea to have a plan.
306.2
MARC: Great, I think so too. Firstly, there is a domestic violence agency that I can refer you too, but only with your permission. They are nearby, and they have women who can help you talk through your situation, and find way out of it – they have a refuge that is in a secret location that you can stay at, if and when you are ready to leave. Secondly, it is important that you know you need to call the police, or go to the hospital anytime, if you feel that things are escalating, or if he is violent again, you need to seek help immediately to protect yourself.
335.1
Thirdly, I would like to see you every week, to check your safety, your physical and mental health, and to give you the opportunity to have regular support. What do you think?
343.9
ZARA: That sounds good. But what if he finds out and does something to me?
349.7
MARC: When I speak to the agency, I will make it very clear that they are to contact you via telephone, if you are fine with that, and not to turn up to your house unannounced, or to send you any post. I will ask them if they can meet you somewhere away from home, in secret.
362.7
ZARA: That sounds good, really good in fact.
366.3
MARC: Now, is there anyone in your family or friends circle that you can speak to about this? Or if you want you can bring someone to your next appointment with me? It’s important for someone at home to know so that you have extra support.
380.5
ZARA: I think my friend Jessica would understand, she is busy with her new job but I think she will come. I will ask her.
389.1
MARC: Is there anything else you want to ask me? Anything at all?
392.7
ZARA: No, you’ve been really helpful, I just didn’t think I would end up telling you this today.
399.5
MARC: No, it’s not easy, but I’m glad we’ve had this chat. And please do come back anytime, we are here for you. Right, so I will make these referrals, here is also the number for the DV organization so you can call them too. I will see you in a few days, and Zara, please be safe. Remember our plan.
416
ZARA: I will. Thanks. Thanks again.
419.3
MARC: Take care, bye now.
Spend a few minutes watching the interaction between Dr Marc and patient Zara, and focus on the following questions.
  • How does Dr Marc react when he becomes aware of possible domestic violence?
  • How does Dr Marc support patient Zara’s disclosure of domestic violence?
  • What follows after the disclosure?
  • Anything you would have done differently if you were Dr Marc?
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Addressing Violence Through Patient Care

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