You have responded to a "Rape"

[crotchitymedic1986]

You are a male medic/emt, and have just responded to a 21 year old woman that has been raped. She has no immediately life-threatening injuries from the rape, so this scenario is not about "medical treatment", but more about human treatment:

What kind of conversation do you have with this patient

1) Do you keep it strictly about medical questions, with long periods of silence after those questions are answered ?

2) Do you make any compassionate statements ?

3) Do you offer advice, or do you stay silent out of fear that you may say the wrong thing.

Physically:

Although we do not routinely make an effort to touch a patient, we do commonly touch them on the shoulder or hold a hand when someone is scared (maybe you have even given a patient or family member a hug when it seemed appropriate).

4) Do you avoid any and all physical contact with this patient ?

5) If you do, do you think that maybe the patient feels she is being shunned, and that maybe your lack of conversation and/or touching is because you see her as "dirty" or "tainted" ?

As usual, I do not think there is a right or wrong answer that fits every scenario, I just wondered what your thoughts were on this subject. If it has been asked before, I apologize, but the search function on this site is pretty useless.

P.S. This question is primarily pointed towards us guys, but if you are female and some advice to offer, it would be appreciated.

[crotchitymedic1986]

15 looks, and no suggestions ????????

[iMac]

It's a difficult set of questions to answer without knowing the exact situation and the mental state of the patient.

I would stick to what I need to know as far as Hx goes and as caringly as I can explain to her that there will be people there for her, healthcare staff here to care for her. I wouldn't push for conversation. If she wants to talk, I'll listen and acknowledge her fears and concerns.

[crotchitymedic1986]

I always followed that philosophy as well, but I recently discovered that a friend of mine was raped years ago. She has progressed to the point that she can talk about it now, and the one thing that she stated that made me reconsider was that she said that she felt like a piece of meat, not a person, by the way that she was treated by the Police, EMS, Fire, and ER people that she dealt with. Not that they treated her bad, or unprofessionally, but because they all "stayed distant" to her, in what she described as her hour of greatest need. She said everyone seemed "cold and sterile" towards her. No one would look her in the eye, touch her, or have a real conversation with her. She thanks god for the "rape counselor" who came to see her in the ER, because she was the only one who treated her like a person, the only one who hugged her and told her it would be alright, the first person to smile with her after they cried together.

Now, I have to wonder if thats what all my patients were thinking ? I wasnt trying to be cold or sterile, but I imagine I might have came across that way, in my effort to do no further harm.

Has anyone ever had a rape counselor to give an inservice for your staff ?

[Michael]

Was the rape-counselor who hugged her a man?

[crotchitymedic1986]

No, but when I asked about that, she said a hug from a man would not have bothered her (I explained the health care professionals might have been distant). I realize that would not be the case for every rape patient, but at the same time is there not room to meet in the middle ? Do we have to be all the way on the "cold" side ? She stated that even the female EMS nurses treated her the same way.

Which is why I asked if anyone has talked with a rape counselor. I am not suggesting that we start hugging every rape patient, but we are usually the first people they see after it has happened, can we be more compassionate without causing harm ?

[ERDoc]

You obviously need to get the medical infomation from the pt. After that it is really patient dependent. Some, like your friend, may want a hug from whoever is willing to give it. Others may not be comfortable with anyone, especially a male, having any form of contact. They may feel as if they are going to be raped again and you will then have to deal with the emotional issues that this will create. The best approach is to judge your patient and adjust your treatment.

[Eydawn]

Be very open with your patient, explain everything you need to do or want to do and give your patient the power and control in the situation. This patient has just had control over their own body wrested from them; give them back their power by not forcing anything on them (unless it's a matter of imminent death or injury and they're too altered to give consent).

Explain that you empathize, and that you will not touch them or do anything that makes them uncomfortable intentionally... ask them if they'd like to talk but emphasize that they don't have to, that this is their situation and you will do what makes them most comfortable. Then respond based on what they say or don't say. Ask before you touch them *every time* unless they say you don't need to ask. Explain that any questions you ask about what happened are just to help provide medical care and that it's strictly confidential between you, the patient, and the doc. (Unless they're a minor and you have to report abuse...)

Not an easy situation. Just be very sensitive to how your patient is reacting to what you say and do, ask them what they'd prefer you to do to make them more comfortable, and be compassionate...

Wendy

CO EMT-B

[crotchitymedic1986]

That all sounds good ERDOC , but here's the kicker: She said, "well I guess I know how AIDS patients feel now". ANd I thought to myself (didnt say outloud), "Actually you dont, because we probably treat AIDS patients with more compassion than we do rape patients".

I am still on the fence about any physical contact, but I wonder if there is a nice way to ask the patient in conversation if she wants to talk about it ? I mean if you responded to a 14 year old girl who was crying uncontrollably, I think you would ask some compassionate questions to try to help her.

Then again, if she wants to talk about the rape, are we qualifed to answer responsibly without doing more damage ?

[crotchitymedic1986]

Good advice Wendy -- thanks