A 38-year-old woman comes to the office due to worsening dysmenorrhea and tension headaches for the past 3 months. She was recently promoted to school principal and says, "It is more stressful than I anticipated; I often have to work late to catch up on paperwork and am not sleeping very well." The patient is married and has no children. While answering questions regarding her sexual history, she bursts into tears. When the physician asks the patient what is upsetting her, she covers her face and says she was sexually abused as a child. Which of the following is the most appropriate response to the patient?

Question

A 38-year-old woman comes to the office due to worsening dysmenorrhea and tension headaches for the past 3 months.  She was recently promoted to school principal and says, "It is more stressful than I anticipated; I often have to work late to catch up on paperwork and am not sleeping very well."  The patient is married and has no children.  While answering questions regarding her sexual history, she bursts into tears.  When the physician asks the patient what is upsetting her, she covers her face and says she was sexually abused as a child.  Which of the following is the most appropriate response to the patient?

Quizplus · Accepted Answer

Physicians must respond to revelations of sexual abuse with clear expressions of empathy and support. Conveying empathy by acknowledging the patient's distress and a willingness to listen to the patient's thoughts and feelings about the abuse is the most appropriate initial response. This empathic acknowledgment will help the patient feel understood and strengthen the physician-patient relationship. Once this initial support is established, further resources and referrals can be offered as needed. Patients will have varying degrees of comfort in discussing prior trauma, and the physician should follow the patient's lead in exploring this sensitive area. Patients should be given the opportunity to talk about the abuse but should not be pressured into doing so. Some patients may indicate that they are not ready or willing to talk more about the trauma. In these cases, the physician should acknowledge the trauma and convey willingness to discuss it in the future. (Choice A) Although referral to a therapist may be indicated later, the physician should initially communicate willingness to hear about the trauma directly. (Choice B) This statement acknowledges the patient's distress but assumes that she does not wish to talk about the abuse. It may also convey that the physician does not want to listen. It is more appropriate to provide an opportunity for the patient to disclose details if she is willing. (Choice C) This response puts pressure on the patient to provide further details without first assessing her willingness to divulge more about the abuse. (Choice D) This statement expresses sympathy (feeling sorry for) rather than empathy (understanding the patient's feelings) and redirects the conversation away from the patient's emotional distress to screening her for symptoms of posttraumatic stress disorder. This could be perceived by the patient as an implicit message that the physician is not comfortable with or willing to discuss her emotions. Asking further questions about her response to the trauma could be appropriate later in the interview. Educational objective: Physicians should respond to disclosure of past sexual abuse with empathy and concern. Clearly acknowledging the trauma and communicating a willingness to discuss it when the patient is ready will help strengthen the physician-patient relationship. __________ References: Standard operating procedures for taking a sexual history. (http://www.ncbi.nlm.nih.gov/pubmed/22970717) Best practices in North American pre-clinical medical education in sexual history taking: consensus from the summits in medical education in sexual health. (http://www.ncbi.nlm.nih.gov/pubmed/30297093)

A 38-Year-Old Woman Comes to the Office Due to Worsening