Domestic abuse is the #1 public health problem in America. One in four women visiting an emergency room has been or is currently, the victim of domestic abuse.  In 2000, 1,247 women, more than three a day, were killed by their intimate partners.[1] The questions raised are: can you tell who is a victim and what can you do to help? The Domestic Violence Health Care Response Act requires hospital personnel in Pennsylvania to universally screen patients for domestic violence and refer appropriate victims to local domestic violence programs. Does your office routinely screen for intimate partner abuse during new patient visits or periodic checkups?

Domestic violence is an ongoing pattern of controlling behavior, used to physically, emotionally, sexually, and psychologically exert power over a current or former intimate partner or family member. It is all about power and control. The consequence of such abuse results in trauma, chronic health problems, including depression, alcohol and substance abuse, sexually transmitted diseases, and limits the ability of an individual to manage other chronic illnesses such as diabetes and hypertension.[2]  In addition to these physical costs are financial costs to the healthcare system (medical and mental care services). Early identification and treatment of victims and potential victims is a universal goal. 

Screening is crucial to identifying victims. Domestic violence does not discriminate with regards to age, gender, ethnicity, religion, socioeconomic level, education, and/or sexual orientation. Many victims do not report their abuser or acknowledge their abuse out of fear, embarrassment, or shame. As a healthcare provider, you can make the difference. The first step is to simply screen your patients. An intervention tool developed by the Massachusetts Medical Society, entitled RADAR, will help you to deal with this very sensitive, yet life threatening situation. 

RADAR

Routinely screen female patients by asking simple, non-judgmental questions in a confidential setting.

Ask direct questions, i.e., Do you feel safe at home? Have you ever been hit, kicked, or punched by your partner? Does your partner belittle or humiliate you in public or with friends/family?

Document your findings and a description of the abuse as described to you, including the name of the assailant. If there is a discrepancy between injuries and explanation, document an opinion.

Assess patient safety by inquiring about weapons and inquiring about frequency and/or severity of violence.

Review options and referrals for any scenario where it is confirmed or there is suspicion of violence, even if denied by the patient. Offer use of a private phone and offer a listing of hotlines and resources - be discrete. 

While open conversation with the patient is important, your clinical assessment is just as crucial. Be aware of any clinical signs that may suggest abuse:

• Bilateral or multiple injuries
• Injury during pregnancy
• Chronic pain with no etiology
• Overprotective partner who gives no privacy to patient
• Injury to head, neck, torso, breast, abdomen or genitals

On average, a victim tries to leave an abusive relationship 7-9 times and requires 15 interventions before successfully and safely leaving for good. Encourage your patients to talk openly, listen without judgment, validate the experience, and provide options and referrals even if you have had the same conversation numerous times in the past. It is everyone’s responsibility to be a patient advocate and intervene, regardless of specialty. By not properly assessing and intervening on behalf of a domestic violence victim you convey a message to the patient, that they don’t matter and that domestic violence is acceptable. MAKE THE DIFFERENCE.