Imagine that you are a community health worker visiting a woman who has missed a couple of doctor's appointments. While sitting in her living room, you notice something disturbing. Just above her wrist are a series of bruises, spaced so they look like they were caused by someone roughly grabbing her arm. There's more. She's in pain, limping badly and seems very despondent. She says she has fallen lately. Maybe something is broken.
Now what? It looks a lot like domestic violence. Should the health worker bring it up? What should be the response? That was one of the scenarios experienced by the students in the Temple University Hospital community health worker program I wrote about in the Philadelphia Inquirer recently. The students were tested, one-on-one, with "standardized patients," people trained to act out scenarios or illnesses so doctors and health care providers can practice. The goal in this case was to get the woman to agree to see a doctor.
I watched some of these from the other side of a one-way mirror and I also listened to a debriefing later. Almost all the students picked up on the possibility of domestic violence, but not everyone brought it up in the conversation. I saw a 20-year-old young man attempting to counsel this woman, a prospect that horrified me. Talk about rushing in where angels fear to tread.
Another man didn't bring it up "because I thought she'd be more comfortable with a woman." Another, a woman, thought that she needed to develop a relationship with woman before she discussed something that sensitive. Others were pretty straight-forward, managing to earn the confidence of the woman enough for her to admit the situation.