SCARF in Health Care
Let’s look at an example of the SCARF and Threat vs Challenge dynamic within healthcare context.
Dr. Jones can feel his pulse rising and his breath shortening as he listens to his long-time patients open up about her struggles with alcoholism and her recent falls at home. He had hoped this would be a brief visit with a familiar patient, but now it is becoming a deeply challenging discussion that may require immediate actions including contacting local law enforcement as she begins to dip into a darker history of domestic violence by her husband and more recent elder-abuse behaviors by her only son.
Dr. Jones feels a deep-ending sense of dread as his MA comes in to remind him that he has a Noon meeting with the Practice Administrator to go over his reduced productivity data and his billing documentation which was flagged by the Coding review committee at their last meeting. And his wife has called to make sure he remembers he has to pick up his daughter for her piano recital at 3pm today because she is meeting with her team in preparation of their coverage of the upcoming Olympics in Paris. A bead of sweat begins its way down his forehead toward his jawbone, which he clinches tightly as his patient continues to dredge up unbelievable stories going on in her life.
STATUS: How does a simple visit in clinic become a threat? Which status is Dr. Jones most focused on? His status as a doctor—looking for solutions for his patient? His status as employee looking to be seen favorably by his supervisors? His status as husband and father who promised his wife that he would pick-up his daughter, something that may become nearly impossible given how his day is suddenly going?
CERTAINTY: He has known his patient for 15 years, yet suddenly she is becoming a far more complex and challenging patient within the confines of his 15 minute schedule. Is what she is telling him true and how does he find certainty to help direct his next actions? Does he need to investigate what is happening since her husband and son are also his patients? Can he call for an immediate family meeting or would that compromise the courage she is demonstrating?
What does she want him to do? Call the police—as a mandatory reporter, he must do so immediately and in written within 48 hours. How will this change his relationship with this patient—particularly if she opposes him reporting it to local law enforcement? How will it change his relationship with her son and husband, who surely will see this as a threat in some fashion? Will one of them sue him or ask for a state licensing review? Patient complaints? Other ways of getting back at him for reporting these events?
AUTONOMY: How much choice does he have right now? Can he ask her to stop and clarify that she has now provided him with sufficient information that he is mandated to report these events to local law enforcement? Will she protest and limit his choices in some fashion? How long will the process of reporting take? Does he need to cancel the rest of his morning schedule to handle this situation? Can he even do that given the concerns about his productivity that he is about to meet with his supervisor about? How does he document this event to demonstrate his professional role with clarity—in service of this patient’s health and in service of legal requirements he must meet? What does he risk if he chooses NOT to report to local law authority—thus placing his professional autonomy above his legal mandate?
