Reducing the Recurrence of Domestic Violence

Simple Steps Physicians Can Take to Help Victims

By Rita Schindeler-Trachta, D.O., and Linda Phan

Battering is the greatest single cause of injury to women in the U.S., more than muggings, rapes and auto accidents combined.(1) The pervasive nature of this societal problem affects one out of three women in this country.(2) One of the most common reasons for females aged 15 – 45 visiting the emergency room is domestic violence.(3)

Physicians play a critical role in stemming the epidemic of domestic violence and sexual assault. We treat the wounds, provide referrals to social workers and discreetly offer resource information in our clinic restrooms. But what else can we do to prevent future violence? What if we could do something that would reduce the chance of domestic violence recurring by 80 percent? There is — read on!

Domestic violence, once addressed primarily by social services or the justice system, is now entrenched as a major public health issue in the United States. Violence among family members is at epidemic proportions and patients with vague explanations of injuries or refusing further medical tests are found in exam rooms across the country. Whether it’s blatant, the odd stare or even just the creepy sense we feel when “something’s up,” we know the possibility and the actual occurrence of domestic violence is real.

We can literally save lives by identifying these individuals, documenting our findings and sharing critical resource information. A domestic violence victim is more likely to seek medical attention rather than contact law enforcement; therefore, we are on the frontlines of stemming the growing epidemic by treating the injuries, and more importantly, intervening and preventing future violence.

Screen for Signs of Domestic Violence

Who is on the receiving end of domestic violence? Domestic violence has no boundaries. People from any age group, race, socioeconomic background, or religion are all susceptible to the problems of domestic violence. While the majority of the victims are women, men and children also fall victim to this epidemic.(4)

How do we identify victims? Many domestic violence victims have vague explanations of injuries or are unwilling to talk about their abuse, making it difficult for physicians to identify domestic violence victims and give the appropriate treatment and referrals. However, there are steps we can take to properly identify and diagnose these patients.

Do you feel safe in your home? Unfortunately, less than 10 percent of primary physicians screen for domestic violence during regular office visits.(5) One of the simplest things a physician can do to improve this statistic is to inquire about the patient’s life at home. As we already inquire about our patients’ intimate medical history, dietary habits and sex life, normalizing the question of whether domestic violence is present in the patient’s home should be as common as asking whether a patient is allergic to a particular drug. Simply ask: “Do you feel safe in your own home?”

Become aware of the emotional and social dynamics of domestic violence. To further identify victims of abuse, we should readily understand the plethora of reasons why victims do not disclose the true cause of their injuries. Some fear retaliation from their partners. The sense of powerlessness or the inability to change their circumstances — due to socio-economic factors — prevents many victims from reporting the violence. Other factors such as the fear of losing their children, cultural barriers or a lack of trust in authorities play a heart-breaking role in their silence.

Keep on the lookout for patients with frequent visits for vague complaints. Consider abuse when the explanation of an injury does not seem plausible or there is a delay in seeking medical treatment. Be especially attuned to pregnant women, a population in which domestic violence increases.

Develop a Protocol for Documenting Domestic Violence Cases

Neither the health care system nor the judicial system can resolve the issues of domestic violence alone. A comprehensive community approach is necessary to truly combat this growing problem. After the treatment of a victim’s injury, physicians still play an integral role in ensuring a victim’s safety by collaborating with the legal community or law enforcement in providing a well-documented medical record.

Statistics show that when a legal intervention is made, the incidence of domestic violence can drop by as much as 80 percent.(6) According to a study published in the Journal of the American Medical Association, a well-documented medical record tremendously helps attorneys win court cases against the abuser.

Also, protective orders (court orders specifying that abusers stay away from a victim) are more readily obtainable when thorough medical records indicating domestic violence are available. Doctors’ thorough accounting of injuries, including legible descriptions, drawings and even pictures, can contribute to securing protective orders from sometimes-skeptical judges.

Provide Referral Information and Safety Planning

We can make a profound difference by saying “I am sorry this happened. It’s not your fault. You have the right to live a violence-free life. Here’s a number you can call.” Besides keeping a list of social service agencies available in the exam rooms, referrals can be dispensed in the same fashion that prescriptions are provided. A list of local crisis shelters, counseling services, and legal agencies that are poised to assist victims should be made available to patients who have been identified as potential domestic violence victims. Since the possession of this information may itself be dangerous to the individual if discovered by the batterer, a phone number on a business card may be the safest route to give referral information to your patient. These cards can easily fit into the lining of a shoe. For those who have succeeded in covering up abuse, they are likely to pick up information at their discretion from restroom pamphlets even if they do not disclose their abuse to their physicians.

A safety plan can be critical in preventing future injuries. Safety plans provide victims with practical advice in ensuring their safety when living with the abuser or after the victim has left the abuser. Usually, service providers at domestic violence agencies provide safety plans to victims who have been referred to them. Since physicians are often the first contact for victims, we are also in the best position to get this valuable information into the hands of victims immediately. Call your local shelter for victims of domestic violence and incorporate their safety plan recommendations into your practice. A list of statewide resources and safety plan information can be obtained from the Women’s Advocacy Project by calling (800) 374-HOPE.

As physicians, we have a direct role in helping our domestic violence patients have an 80-percent chance of not getting abused again if we:

• Identify the individuals at risk of domestic violence, or on the receiving end of it;
• Document the medical record with a careful inventory of the injuries; and
• Provide safety and referral information as critical elements of the medical treatment.

Following these three steps, we can help our patients on their pathway to a violence-free life.

Reporting suspected abuse: As a reminder, physicians are obligated to report suspicions of abuse or neglect of adults or children to the Texas Department of Protective and Regulatory Services at (800) 252-5400.

RESOURCES:

National Domestic Violence Hotline

(800) 799-SAFE (7233)

www.ndvh.org

Women’s Advocacy Project

(800) 374-HOPE (4673)

www.women-law.org

Since 1982, the Women’s Advocacy Project has provided free legal advice to Texans, with specialized services addressing the legal needs of victims of domestic violence. The project provides services through eight programs including legal hotlines, emergency protective orders, assisted and non-assisted pro se programs, technical advocacy, justice and legal initiatives, and outreach programs. As part of the outreach program, the project provides free brochures in English and Spanish listing toll-free hotline numbers. They also make available easy-to-follow personal safety plan flyers.

For more information or to receive printed materials, contact the project at hbellino@women-law.org. Placing these materials in your ladies room is an opportunity to help victims in a safe manner that would not otherwise present itself.

Doctors interested in getting involved with the Women’s Advocacy Project are urged to call the administrative line at (512) 476-5377.

Endnotes

1. Copel, L., and Baron, D. (1997). Recognition and Treatment of Partner Abuse in Primary Care. Journal of the American Osteopathic Association, 1997, May; 97 (5 Suppl):S7-S14. See also Federal Bureau of Investigation, U.S. Bureau of Justice. (2003). Uniform Crime Reports for the United States, pp 27, 31, 37. See also “Family Violence and the Health Care System.” University of Houston Health Law and Policy Institute. February 1997, p 35.
2. Common Wealth Fund Survey. (1998).
3. “Family Violence and the Health Care System.” University of Houston Health Law and Policy Institute. February 1997, p 35. See also Common Wealth Fund Survey. (1998).
4. Common Wealth Fund Survey. (1993 and 1998).
5. Rodriguez, M., et al. (1999). Screening and Intervention for Intimate Partner Abuse: Practices and Attitudes of Primary Care. Journal of the American Medical Association, 282, 468-474.
6. Holt, V., et al. (2002) Civil Protection Orders and Risk of Subsequent Police-Reported Violence. Journal of the American Medical Association, 288 (5), 589-594.

About the authors

Rita Schindeler-Trachta, D.O., is founder and owner of Austin Family Medical Clinic in Austin, Texas. She is a 2000 graduate of UNTHSC/TCOM and board certified in family medicine. She serves on the board of directors for the Women’s Advocacy Project, a Texas statewide non-profit organization dedicated to providing free legal services for any Texas victim of domestic violence.

Linda Phan has worked extensively with domestic abuse survivors through many of Texas’ most respected organizations, including SafePlace and the Women’s Advocacy Project. She is currently the executive director of Saheli, an Austin-based organization that provides assistance to Asian families dealing with domestic violence and abuse.