Doctors make a difference in treating abuse

Mounting evidence of long-term health effects -- even after the violence stops -- adds to pressure on physicians to more effectively screen domestic violence victims.

By Victoria Stagg Elliott, AMNews staff. July 22, 2002.

The woman showed up in the emergency department with injuries her treating physician thought could be the result of intimate partner battering. Despite the patient's denials, the doctor gave her a card with the phone number of the local domestic abuse hotline. And it turned out, his actions would ultimately make a difference. Secretly, this woman held on to the card for five years by taping it to the back of her refrigerator. One day, she finally called the number. It was the step that helped her leave the abusive relationship.

She now regards that physician as the person who saved her life.

Still, this particular patient, one of the subjects in a series of case studies involving victims of domestic violence, by Christina Nicolaidis, MD, MPH, is an example of why it's so hard for physicians to be involved in the issue.

"The physicians aren't seeing that they're having the effect they are having," said Dr. Nicolaidis, an assistant professor of internal medicine at Oregon Health Sciences University in Portland. But when asked, survivors often say that their doctors' questions made a difference in their lives, even if they didn't acknowledge the problem at the time. "It educates them that it's not OK that their partner pushes and shoves or is really controlling," she said.

In general, domestic abuse is a complicated problem that frequently defies the quick fix.

Physicians rarely see a "cure" because of their efforts, certainly not in one visit. Some physicians believe that patients will volunteer the fact that they are being abused without being asked, although this is not borne out by studies. Research has shown that patients, whether they are victims or not, believe that it is important for physicians to ask. But surveys of physicians have found that they rarely do. Doctors may not be comfortable with the subject, may fear that it would take too much time, may not know what to do with patients if they admit to being abused, or may regard the problem as a patient's private matter. [...]