In a physical therapy screening, a patient presents with difficulty concentrating and fear of touch. Which screening approach is MOST appropriate?

• A. Ask direct questions about violence or abuse.
• B. Ask indirect questions about violence and abuse.
• C. Ask direct questions about substance abuse.
• D. Ask indirect questions about substance abuse.

Answer: (A)

When a patient shows signs that could reflect trauma—like trouble concentrating and fear of touch—addressing safety and potential abuse directly is crucial. Asking direct questions about violence or abuse clearly signals that these concerns are important in care, invites honest disclosure, and helps you plan appropriately for touchy assessments or manual therapy. This approach supports informed consent, helps identify immediate safety needs, and allows you to connect the patient with resources if needed. Indirect questions about abuse can be too vague and may not elicit a disclosure, leaving the issue undisclosed. Questions about substance abuse, while sometimes relevant, don’t directly address the safety and trauma cues you’re seeing here. So, a straightforward, respectful inquiry about violence or abuse best fits the patient’s presentation and guides safe, effective care.