Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Asking Hard Questions


In the ED, my adolescent patient shared that she was being sexually abused. It reminded me of the importance of creating a safe space for courageous conversations. 

An adolescent girl came to the ED for abdominal pain. She’d had multiple visits for this same thing and her evaluation didn’t show anything. Because she was young, I asked the family member present to leave the room so I could perform a HEADSS exam, the psychosocial interview for adolescents that covers their home and school environments, education, activities, drugs, sexuality, and suicidality. Along with this interview, I asked her if she had any ideas as to why her abdomen hurt. She became quiet and I sat there silently next to her. After a few moments, she said that a family member had been sexually abusing her since she was a child. To be frank, I wasn’t expecting this. We were able to remove that family member from the ED and her mother arrived. We contacted social work, police, and child protective services. I walked her and her mother through each step of this visit and what would happen after her ED visit. With each new person she met, she and her mother requested that I be in the room for the initial stages of their conversation.


Before they left, the mother took me aside and asked if she could hug me. She thanked me for taking the time to listen to her daughter and gain her trust. For me, this validated why I take the time to ask hard questions. 


My conversation with this patient was an integral part of giving exceptional care. Relationship-centeredness enabled me to create a space where she could come in, despite having been told on many other occasions that there was nothing wrong, and talk to me about what she was experiencing. I hope she’s out there getting the support and care she deserves.


While the COVID pandemic has led to more fatigue than I have ever experienced, when I feel at my lowest, I think of patients like this girl. They are why I do this. 











This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.