Domestic Violence
Healthcare Consequences
Why is it important for healthcare professionals to ask about abuse?
One day after reading an educational booklet on domestic violence, Richard Jones, former president of the American College of Gynecologists and Obstetricians, asked a long-time patient whether her husband had ever beaten her. To his amazement, she replied, “Doctor Jones, you can't imagine how long I've been waiting for you to ask me that question.”
Healthcare professionals are in the critical position of providing
services to victims of violence as the first contact point for many victims.
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Researchers estimate that more than 1 million women each year experience non‑fatal violence by a husband or intimate partner in the United States.
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Among women seeking care in hospital emergency departments, approximately 35% are treated for injuries caused by a violent husband or boyfriend.
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In homes where partner abuse occurs, children are up to 1,500 times more likely to be abused than in homes without such violence.
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Battery is a leading cause of serious injury to women in the United States, exceeding injuries from rape, mugging, and auto accidents combined.
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Men’s violence against women has been identified as a major contributor to infant mortality and some preventable birth complications.
Common Diagnoses
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Sprain and Fractures
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Fractures associated with falls due to being pushed and/or shoved
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Fractures of the forearm are commonly seen when the woman attempts to shield herself with her arm
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Facial and orbital fractures from direct blows to the area of the eyes
Mental Health Symptoms
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Depression
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Substance Abuse
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Drug abuse
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Post-traumatic stress reaction/disorder
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Suicide attempts
Medical Signs
During Pregnancy
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Injury to the breasts, abdomen and genital area
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Pre-term abortions, bleeding, miscarriages, and premature labor
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Abused women are at a significantly higher risk of having intrauterine growth retardations and low-birth weight infants.
Clinical Indicators
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Chronic pain
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Dental problems
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Frequent use of prescribed tranquilizers or pain medications
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Physical symptoms related to stress
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Panic attacks
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Eating disorders
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Chronic headaches
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Gastrointestinal complaint
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Head and spinal injuries
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Burns and bites
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Sprains and fractures
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Contusions, bruises, and lacerations
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Self-Inflicted injuries
Clinical Indicators of Sexual Abuse
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Frequent vaginal and urinary tract infections
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Chronic pelvic pain
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Pelvic Inflammatory Disease with negative lab findings
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Recurrent sexually transmitted diseases
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Irregular vaginal bleeding
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The sexual abuse victim will not usually disclose that they have been abused
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Pain and fear upon examination
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Poor contraceptive compliance and/or multiple therapeutic abortions
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Sexual dysfunction
How to Assess Domestic Violence
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Interview patient in private
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Start with an opening supportive statement
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Ask questions in a direct, non-judgmental manner
Ask the Patient Directly
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Have you been hurt or threatened by your partner?
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Many women experience some type of physical abuse in their lives. Has this ever happened to you?
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Im concerned that someone has hurt you, can you tell me how it happened?
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If you were experiencing violence in your home, would you know where to get help?
Validation
Even if a patient is not ready to leave a relationship or take other action, your recognition and validation of her situation is important.
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Examples of Validating Statements:
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No one has a right to hurt you, it is wrong and illegal.
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We are finding that many women experience violence in their relationships. You are not alone.
Treatment
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Couples counseling or family intervention is contraindicated
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Prescribing tranquilizers may inhibit a patients ability to take action or protect herself
Documentation
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Photographs (consent is required)
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A hand-drawn body map with injuries labeled
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Documentation of the alleged incident including names and/or relationship of alleged perpetrator
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Documentation of any inconsistencies between physical findings and the patients explanation of the cause
Immediate Care
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Is it safe to go home?
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Are the children/other dependents safe?
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Is there a need for immediate sheltering?
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Are there friends/family to stay with?
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Is there a need for urgent crisis counseling?
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Does she know about community resources?
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Is there a specific plan for a quick exit?