Practical Wisdom: Some Early Morning Inspiration

It's a foggy, cold morning here at the Naval Justice School, and I am frankly, exhausted. I've had some fascinating conversations in the last 24 hours with many, many lawyers (both prosecutors and defense counsel, sometimes more than one at a time). One of the threads of our conversations has been balancing, or in some cases, marrying, the forensic with the clinical; making decisions that are patient-centered vs. investigation-centered. Deviating from protocols in favor of processes that make patients more comfortable, more in control. I don't know how many different ways I can say that my obligations are to my patient and that as a clinician, there is a measure of clinical judgment that must come into play when I am caring for said patient. But in talking with lawyers and investigators, I understand that these concepts are not always obvious, are at odds with the priorities of the criminal justice-focused professionals, and so they have to be part of the conversation.

However, I despair that I am still having these conversations with clinician colleagues. (Is that too strong a word? Maybe, but it's so gloomy here in Rhode Island it seems fitting.) Last week I talked with a colleague about her exam process. And she told me she never deviated from how she did the exam and kit collection. Never. I asked her, well what if the patient had needs that necessitated altering your process. And she replied that she would simply explain to the patient why it was important to follow the same steps every time, and to date she had never had a problem with it.

If you precept and mentor SANEs and SAFEs, you may have made some similar observations: that the best ones out there are flexible on their feet, can think in more than a linear fashion, and are capable of putting down the box and sitting with a patient and saying "tell me what you need". That when patient care comes first, and evidence collection comes farther down the road, everyone involved benefits. Because I've provided solid patient-centered care; because I have individualized the care for that particular patient; because any evidence collected was done as a courtesy to my patient, at her behest and with her cooperation, making it more reliable and less rote; because by taking this approach I may actually increase the likelihood of her reporting; and because, should this case go forward in the courts, I end up being a stronger, more objective witness for it all.

Please keep in mind I am in no way advocating you abandon protocols, policies or procedures. Nor am I saying that consistency of practice is a bad thing. What I am saying is that sometimes, in order to put the needs of our patients first, deviations are required. That the kit should not drive the encounter, the patient should.

Because I feel like I've had this chat so many times in the past week, it's starting to wear me down a bit. So this morning I'm needing a bit of inspiration. In times like these, I turn to TED: Ideas Worth Spreading. There is a lifetime of inspiration to be found on this site and I'm rarely let down by the segments I watch. So for your viewing pleasure on this foggy, cold morning (at least where I am), I give you Barry Schwartz and his very insightful discussion on practical wisdom. Please listen to it for what it is--a fantastic treatise on independent thinking in our current social and political climate. There isn't anything about sexual assault here, but there are some interesting ideas about issues like ethics and human connection and teaching. I look forward to hearing your thoughts.

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