Mock 28: patient who may not have told entire story

[Guest Koggetsu]

can't remember the exact wording but it goes something like this:

 

A patient u are seeing seems to not be telling the whole story about her problem and seem to be hiding something. U suspect that she maybe being abused by her husband (or something like that) How would u handle it? Would it be your obligation to notify someone about it?

[Guest Kirsteen]

Hi there Koggetsu,

 

This is an interesting question: does anyone know the law (I don't! ) surrounding this type of issue? I thought that if there was suspected abuse of a minor then that is reportable by law, but as to an adult, I'm not really sure.

 

Part of my uncertainty comes from my own experience as at the clinic where we work, we are not required to report any potential spousal abuse (of which I'm aware). If we suspect abuse, however, then we are encouraged to remind the client that they are within a safe environment where they have the freedom to talk and seek help.

 

Does anyone else (perhaps some of the social workers out there) have any accurate insights? It would be helpful to know.

 

Cheers,

Kirsteen

[Guest UWOMED2005]

For Ontario:

 

Suspicion of Child Abuse = Mandatory Reporting

Any medical condition that impairs ability to drive = Mandatory Reporting to Ministry of Transportation

There's a third scenario I'm not remembering at the moment.

And I think there's some cases of infectious diseases (ie Meningitis, Smallpox, AIDS I remember being complicated) being mandatory reporting to the Local Health Unit.

 

If it's a problem of a psychiatric nature, and you have reasonable cause to believe they're going to harm themselves or someone else, you can use the notorious "Form 1" in Ontario to have them committed to a psychiatric institution for 72 hours for evaluation.

 

But other than these extraordinary scenarios, there's not much to do if a patient is lying. If it's a matter of them being sick and not telling you about symptoms - it's their loss as you can't really do much about that.

[Guest Dannyboy]

If my memory serves me right the third condition involves harm to others. If a client indicates that he/she will harm someone else *and* that person is identifiable then you have a duty to contact the police. However, if someone says more generally that they just feel like causing harm, you are in a big fat grey area. That whole client confidentiality thing gets tricky. Form 1 may apply but......tricky.

 

As far as abuse is concerned, Kirsteen is, from my understanding, correct. It is the client's choice to disclose. This gets complicated if you suspect that the child is exposed to ongoing abusive situations---is that then a form of abuse?? Not legally reportable but ethically?? What if both the suspected abuser and the couple's offspring are your clients?? Thorny.

 

I would personally never use the word "lying" in a formal setting (but fine how it was used). Especially with abuse, our system bites for adequately responding to the needs of those in abusive situations. The individual may not be disclosing for good reasons.

 

As well, if my tired memory serves me correct, the rules according to infectious diseases is provincial specific and yeah, the AIDS rule is complicated--anyone know it or can explain it according to Ontario's rules?

[Guest dangrrgrrl]

Things like smallpox, meningitis, measles, pertussis, and hepatitis A are all reportable. Currently, HIV is not a reportable disease HOWEVER this was under review (by BCCDC as of mid Feb) and reportablility is scheduled for implementation in Spring 2003. The information will remain confidential but will be used for contact tracing. In fact, names will not have to be reported, according to Dr. Mike Rekart (BCCDC, I think) at a recent conference.

[Guest grandmellon]

I also believe that it's not anyones perrogative to report such a thing unless its a child abuse situation. The best thing to do is, like mentioned before provide and remind them of the safe atmosphere, help them plan for the future by giving them phone numbers and addresses to shelters. In essence giving them an escape plan. The most dangerous period of time in abuse relationships is not when the abuse takes place but when the person tries to leave, so this is where preplanning is very important... my 2 cents... 8o