Vice President Joe Biden spoke at the National Conference on Health and Domestic Violence on Friday, and he stated that domestic violence is a public health epidemic.
Biden made attendees — including doctors, nurses, social workers, etc. — aware that even though we've come a long way in the fight against domestic violence, we have to keep making sure we're working harder than ever for prevention and intervention. Of course, it takes a little bit of time to recognize domestic violence, and it's important for healthcare professionals to know the signs.
When we hear the words domestic violence, we automatically think its physical, but it's more than just that. The Centers for Disease Control and Prevention often uses the term intimate partner violence (IPV), while other agencies refer to it as domestic abuse to highlight more than just the physical part of the situation — including psychological/emotional abuse, threatening and stalking.
It's the result of power, control and coercive behavior of one individual over another in a particular relationship. It does not discriminate, and it can happen to anyone regardless of gender, race, sexual orientation, etc.
It's hard to know how many cases of domestic violence occur, but Safe Horizon reports that 1 in 4 women will experience domestic violence during her lifetime, and men are victims of about 3 million physical assaults in the U.S.
A study in the Michigan Family Review showed that most healthcare professionals are incorrectly influenced by societal misconceptions including:
- Domestic violence is a rare occurrence.
- Domestic violence is a private matter.
- Domestic violence does not occur in "normal" relationships.
- The victim could be held responsible for his/her abuse.
With that said, though, it's up to everyone — healthcare professionals and society as a whole — to look past the misconceptions and get to the root of the problem.
The U.S. Department of Justice reported that 37 percent of all women who sought care in hospital emergency rooms for violence-related injuries were injured by a current or former spouse, boyfriend or girlfriend.
Because of this violence, studies in the Journal of Psychiatry report that 56 percent of women involved in domestic abuse are diagnosed with a psychiatric disorder, 29 percent attempt suicide, 37 percent have symptoms of depression, 46 percent have symptoms of anxiety disorder and 45 percent experience PTSD.
A study in South Medical Journal reported that 68 percent of patients [women] were able tell their doctors that they were abused, and only 12 percent had been asked about it. But within the ones who opened up about their abuse, 20 percent of them had not been helped by their doctors.
Another speaker at the National Conference on Health and Domestic Violence was emergency physician Yolanda Haywood, who discussed a domestic violence episode of her own. Haywood told attendees that she arrived to her emergency room shift late one night after her husband punched her in the mouth.
During her time in the ER, several medical professionals saw her, but none asked her how she received the injury. Finally, the doctor treating her injury asked after he sutured her lip.
"I became hopeful," Haywood said. But when she said it was her husband, the physician stated that she needed to "learn to duck," which Haywood actually learned to do over the next several years instead of finding the support she needed.
Haywood was a victim who knew what was going on in her life and wanted to receive the help from medical professionals. But in most instances, victims don't notice themselves as being abused and have barriers that hinder them from even discussing the situation with a professional, according to "A Guide for Domestic Violence Advocates" by Futures Without Violence.
Some barriers may include:
- Fear that revelation will jeopardize safety
- Shame and humiliation at the way the patient is being treated
- Feelings of protectiveness toward the partner
- Lack of awareness that physical symptoms are caused by the stress of living in the hostile environment
- Belief that injuries are not severe enough to mention
Because of these barriers, it's imperative that healthcare professionals consistently ask direct, specific questions about abuse. So how do you begin?
The American Medical Association created "Diagnostic and Treatment Guidelines on Domestic Violence," which illustrates many scenarios that healthcare professionals can go through in order to discover domestic abuse in their patients.
Some examples of recommended questions to ask your patients are:
- Are you in a relationship in which you have been physically hurt or threatened by your partner? Have you ever been in such a relationship?
- Are you (or have you ever been) in a relationship in which you felt you were treated badly? In what ways?
- Has your partner ever destroyed things that you cared about?
- Has your partner ever threatened or abused your children?
- We all fight at home. What happens when you and your partner fight or disagree?
- Do you ever feel afraid of your partner?
- Has your partner ever prevented you from leaving the house, seeing friends, getting a job, etc.?
Some types of injury and medical findings seen in healthcare professionals' offices include, but are not limited to:
- Contusions, abrasions and minor lacerations, as well as fractures or sprains
- Injuries to the head, neck, chest, breasts and abdomen
- Multiple sites of injury
- Repeated or chronic injuries
- Physical symptoms related to stress
- Anxiety disorders and depression
- Chronic headaches
But what happens when abuse is recognized? AMA suggests several interventions that are possible, but also states that "optimal care for the patient in an abusive relationship also depends on the physician's working knowledge of community resources that can provide safety, advocacy and support."
The organization states that the patient's safety should be a number one priority, and healthcare professionals should inquire about the safety of the patient before he/she leaves the medical facility.
Many agencies have reported that well-documented medical records are extremely important for preventing further abuse. The records also create concrete evidence for the victim if any legal action were to come about.
These few examples are only the beginning to identifying abuse within your patients. It's up to the individual clinician to learn more about these serious situations in order to help their patients.
"What was lost that night in the ER was the opportunity to offer hope and compassion to a young woman who needed help," Haywood said. "Hope and compassion are great medicine, not just nice words that pacify."
