I have been a physician assistant for more than 20 years now, but I encountered one of my most memorable patients in my first year in practice. I was working at the women’s clinic for a county health department. A new patient came in for her routine annual Pap smear examination. She had her young son with her. During the exam, I noticed some suspicious bruises on her arms and asked her how she got the bruises. She said that she did not recall, but I could tell by the look on her face that she knew. I told her I was concerned for her safety and asked her if she was being abused. She said, “no.” I still shared with her resource information and phone numbers and encouraged her to seek help if she ever felt that she and/or her son were in danger. She thanked me and walked out of the clinic.

About 6 months later, I received a letter from this patient. She thanked me for recognizing her abuse. She said that I was the first person to ever ask her about her bruises (which she frequently had), and my asking her about them made her realize that she could not hide the abuse and be in denial anymore. She informed me that a few weeks after her appointment with me she had found the strength and courage to leave her abusive husband. She and her son had moved out of state, were living with family, and were safe! 

This patient taught me a very valuable lesson. Sometimes it is hard to ask our patients personal questions. We don’t want to assume the worst or offend our patients. But if we aren’t asking them, who is? We have to be the strong ones and be advocates for our patients. It’s our job, and they are depending on us.—Linda New, PA-C, DeBary, Fla.

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These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.