Kim Day (of SAFEta acclaim for the handful of folks who don’t already know her) and I were talking last week about the word “evidence” and our move away from it when we speak about the work we do. I liked what she was saying so much, I asked her to write a guest post, which she graciously did amid all her other projects. Thanks, Kim, for the thoughtful offering. I look forward to the continuing conversation on this topic:
Language is so important in the work we do. I was teaching a group of prosecutors a few weeks ago, and it struck me that we use the word or term “evidence” rather loosely in practice and even in teaching activities. We talk about the process of evidence collection in teaching sexual assault nurse examiners, and other community partners. We may tell the patient that what we are doing in the medical forensic exam process is “collecting evidence” or we ask permission to “collect evidence” from them. Is that really what we are doing?
Webster defines evidence as an “outward sign” or indication, or something that furnishes proof, something that bears witness. As I reflected on the patients we care for, I realized that we set the expectation of a legal outcome from the very beginning by calling the items we collect in the exam “evidence”. When caring for any other patient population, we do not call the samples we collect from them, evidence- and in many instances (in fact in only about 9/100 ever even reach the venue of a courtroom, and 12/100 reports result in an arrest) the samples we are collecting from the patient who we care for after a sexual assault NEVER reaches the point of becoming evidence. Are we setting a false expectation when we describe what we are collecting from them as evidence? It was then that I came to what I will call an “ah hah” moment- and realized that this IS something that can contribute to misinformation and it is being perpetuated by those of us who work in this field and in a broader sense our partner professions who also work with patients/victims.
The samples we collect from the patient at the time of the medical forensic exam are just that- samples of materials, secretions, debris, whatever- they are merely samples (or specimens if you want to call them that). We collect them guided by the history that the patient provides us- much the same as every patient we treat in healthcare. Care is customized for each patient based on many things- chief complaint (sexual assault), symptoms (pain, injury or method of assault), physical assessment (which we do during the exam); sample collection will proceed from there. We may collect blood, urine, materials whatever the source, we collect them based on the information we have. They are nothing more than samples or specimens. When we use this approach to what we do, we do not set an expectation that these samples we collect are going to do anything more than any other specimen that we collect in healthcare. They may or may not be used or even processed (the lab, the courtroom, or anywhere else).
One of the things that I strive to teach clinicians who do this work is that we MUST NOT step outside of our role as healthcare provider in the care of this particular patient population. We must strive to treat the patient who has the chief complaint of “sexual assault” as every other patient we see- following a model of care that provides ethical, holistic, compassionate care using an evidenced-based practice approach. If we follow that principle, we will never fall into the “trap” of becoming an “arm of law enforcement” or an “evidence collector”. When we describe what we are doing (sample collection) or what we are collecting in legal terminology (evidence collection), it becomes very easy to continue on that path and refer to the healthcare encounter (medical forensic exam) we are conducting as a legal process (evidence collection). I, for one, am NOT an evidence collector– I am a healthcare provider. I provide CARE to my patient- and when providing that care, I may or may not collect samples from the patient (only if they desire that).
I am making a conscious choice to change the language I am using- I will refer to the samples collected during the course of the encounter (medical forensic exam) with the patient who has experienced sexual assault as just that- samples (or sometimes specimens perhaps), but my plan is to no longer use the word “evidence”. Perhaps this will start a new dialog- one that can bring up back to the healthcare as the primary focus of the exam- not the legal system.