You are working in your routine health professional environment, and so far your day has been uneventful. You are the senior member of your health team.
During a routine conversation with a client (Sarah) - a 23 year old woman with a fractured tibia, and an otherwise unremarkable clinical history - you are confronted with a dilemma.
Sarah seems agitated and red-faced. You ask her what is wrong.
She is reluctant to talk so you ask her again. Sarah starts to cry and says:
“Do you know how I broke my leg?”
You don’t know.
“It wasn’t an accident. Alan smashed it on purpose.”
You are shocked and ask Sarah if she reported this to the police.
“If I did that he would kill me.”
You ask if she would like to write down what happened so there is a record, and so that further discussion can occur.
“I told you, if I do that and he finds out he will kill me. He called me just now, he’s broken into my flat, he’s waiting for my flat mate. He says he is going to break her legs too.”
You ask Sarah if she has warned her flat mate.
“No way. He will kill me if I did.”
Can you call the police?
“What can they do, she’ll be home in ten minutes ... can you help me please?”
You are unsure what to do.
“Here’s her number, can you call her and warn her not to go to the flat?”
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What do you do? Do you have a role here? Is Sarah telling the truth? Is Sarah mentally ill? Should you get involved in a situation where there is only hearsay? Do you have duty to do what your patient asks? Do you have a duty only to your direct patient? Do you have a duty to people beyond your patient? Are you primarily a health professional or a citizen?
If she is telling the truth and you warn the flatmate, will this solve the problem?
If she is not telling the truth and you warn the flat mate, are you vulnerable? Have you breached confidentiality? What if the flatmate is actually Alan’s partner and Sarah is a jilted lover? What if the supposed ‘flatmate’ is Alan’s partner and she knows nothing of Sarah? What if Alan and Sarah have had a secret affair that ended acrimoniously?
But what if you can prevent a violent incident and save the flat mate from serious harm?
What do you do??
It is proposed that you call Sarah’s flatmate and warn her that she is in danger