Summary: Eliciting Medical History
In light of the general information that is available about the population of women who are in jail, Bianca’s history is likely to be complex. Eliciting medical history will require a complete assessment of the client’s medical, pregnancy, gynecologic, cancer and exposure history to determine an appropriate differential diagnosis, rule out potential inherited disorders, identify teratogenic exposures, etc. Every aspect of the history is important. Assumptions pose a significant threat to eliciting medical history and to truly understanding the patient. Assumptions are often grounded in cultural stereotypes and biases. Further, your emotions may negatively impact your ability to fully focus on the client. If you are concerned that your emotions may get in the way of eliciting medical history, use standardized intake forms that can help you stay on track.
During the session, if you are concerned that Bianca has not been properly screened for mental health issues, the genetic counselor can integrate several questions from routine screening tools into the medical intake procedure. The National Institute of Justice created two brief gender-specific mental health screening tools, the Correctional Mental Health Screening (CMHS) and the Brief Jail Mental Health Screening (BJMHS). Visit Mental Health Screens for Corrections.pdf to access these screening tools and consider how you might use or adapt them for the genetic counseling intake protocol. If you believe that Bianca has mental health concerns, after asking Bianca her permission to do so, touch base by phone with the prison doctor to communicate your insights. Unfortunately, in Bianca’s session, the genetic counseling encounter ended prematurely, leaving you with more questions than insights into her mental health status.
Providing suggestions for resources and support information may be futile if the resources the client needs are not available in the prison environment. Genetic counselors often suggest online resources and support groups for clients. But, what do we know about the resources available to Bianca? Does she have access to computers in the Greenville facility?
Assume that she does, it will be important to ask. The genetic counselor or the social worker in your center should print out relevant information for Bianca to take with her. Relevant information may include facts about causes and treatment of the fetal heart defects, recommended prenatal care and tests, and information about delivery and surgical options for a fetus with this heart defect. It is unlikely that a support group will be available to Bianca in prison. However, this is a point that the counselor may wish to explore with the specific facility, especially if the facility makes regular referrals to the genetics center.
A general support group to help inmates deal with issues of loss and grief may be available. Intake questions including those intended to elicit medical history can inadvertently divert a genetic counseling session in ways that ultimately break down, rather than facilitate, counselor-client communications. By focusing on Bianca’s history of alcohol and drug abuse, the genetic counselor failed to consider other potential causes of the abnormal ultrasound.
When Bianca shared with the counselor the reasons she had abused alcohol, she made herself emotionally vulnerable for a fleeting moment. Admitting to previous experiences and her struggles coping with unfortunate life decisions could have facilitated intimacy and behavior change within the genetic counseling session. Instead, the counselor’s biases affected the dynamics of the session, and vital steps in genetic counseling process were overlooked. By failing to engage Bianca in a discussion about her psychosocial history, the counselor missed an opportunity to understand Bianca for who she was, who she currently is, and who she wants to be, in light of the ultrasound results.
