Based on my patient’s description of her domestic situation, I do not have reasonable cause to suspect that her husband’s behavior constitutes domestic violence as defined by the state in which I practice rheumatology; the mandatory reporting statute of my state does not apply. Nor do I have an ethical obligation to report this domestic situation.
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Explore This IssueApril 2019
My determination of obligation in mandatory (legal) reporting should be grounded entirely on the facts as I understand them and the level of suspicion of domestic violence. The fact that my patient’s husband may become my patient should not influence any decision to appropriately report to the oversight institution if IPV is suspected. Conversely, if he were established as my patient, I would then have an ethical obligation to him as well, and his interests would necessarily enter into my calculus. Most would maintain, however, that a legitimate suspicion of spousal abuse would supersede the physician-patient relationship.
In this clinical scenario, my patient’s relationship with her husband is significantly strained, and she is clearly suffering. Under the principle of beneficence, my ethical obligation is to help my patient in whatever way I can. I believe that both my patient and her husband would benefit from psychotherapy, couples counseling and/or treatment by a psychiatrist. There is no easy solution to this situation, but it is my ethical duty to provide access to the resources that would be most beneficial. I make this recommendation to her, and she is relieved to know that avenues for help are available.
Although this representative clinical scenario does not illustrate an example of domestic violence that must be reported, it does bring to light an important dimension of patient care. Physicians seek to advance the well-being of patients through clinical evaluation and management on a daily basis, but it is equally important—and perhaps more challenging—to ensure patient safety at home.
It is entirely possible that you will encounter domestic violence or suspected abuse in your practice; given the numbers, many of us likely have already been confronted by a similar situation. Being familiar with the laws concerning mandatory reporting in your state will provide legal guidance to complex encounters.
As physicians, we already seamlessly incorporate justice, patient autonomy, beneficence and non-maleficence into our daily medical practice; we should, therefore, view patient safety, including domestic violence, through the lens of these guiding ethical principles.
Sarah F. Keller, MD, graduated from the Massachusetts General Hospital Rheumatology Fellowship Training Program in 2016. She practices rheumatology in Crestview Hills, Ky.
Marcy B. Bolster, MD, is associate professor of medicine at Harvard Medical School and director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital in Boston.