I have been paying attention to some of the recent events around the L-A area and have been deeply saddened by what has occurred over the past few weeks. Between murder-suicides and murder robberies one becomes starkly aware of the human condition. While it is fairly obvious to most health care professionals in Maine that domestic violence is one of the state’s not- so-secret dirty secrets, when these events occur they make most of us shudder. Fortunately, violent crime in rural Maine is not so great that we have become numb to it. A friend of mine works at two of the county hospitals in Brooklyn known notoriously for the amount of violent crime they see. Over time, health care workers begin to become numb to the violence as the violence is seen as part of the culture. Patients are not treated as human beings, but as objects. Then cynicism begins to set it: “Why should I fix this person’s stab wound when I know that they are going to get out of the hospital and attempt to take revenge on the person who stabbed them.” In this type of environment, where brawls will erupt in the ED and patients have been gunned down on a gurney as they were being wheeled into the hospital – it can be difficult to retain hope. Honestly, is an excellent vascular surgeon going to fix the root cause of the problem?
In rural Maine our violence is more subtle. It goes unheard and unspoken for much of the time. I believe this is why we have to be even more on guard – domestic violence impacts our patients more than we understand and it certainly impacts the relationships we have with our patients. Often this gets lost when we are taking care of patients. Recently I was helping take care of a patient who was refusing treatment. Initially, I was very frustrated because she was pregnant and her choices were affecting the health of her baby. She outright stated that she did not trust doctors (I was pretty sure this meant medical students were certainly not to be trusted). Eventually I was able to spend some time with the patient and she admitted to me that she had been abused and was extremely fearful of situations where she was not in control. I began to understand the patient’s perspective and had to examine myself for my own shortcomings of initially ignoring her anxiety. It is true that this patient had some serious problems, but that is no excuse for me to become frustrated and ignore these issues.
Currently, Maine is in poor economic condition. Our current unemployment rate is 7.7%. People are stressed out. The past 3 years of financial recession have taken their toll and problems of domestic violence are only exacerbated by these conditions. As health care professionals it is our duty to not only be aware of domestic violence, but to listen to our patients and make sure they know they have resources for help. Listening to our patients’ stories gives them a voice, and it reassures them that they are human beings. I am not so naïve to believe this will change the course of domestic violence in Maine, but I do know that it means a great deal to our patients. Fostering a culture that cares deeply about patients’ social needs is actively resisting the culture of cynicism that will set in if we are apathetic. This is not easy to do, it takes effort and it will exhaust you physically and emotionally, but it is the right thing to do. I will be the first to admit, that I am often lazy and will focus my attention on the medical problems of the patient and ignore their social concerns. Unfortunately, these two problems are closely intertwined and if I fail to address the social concerns I know that there is a much lower likelihood of successful medical treatment.