Data from the CDC on intimate partner violence is staggering. About 41% of women and 26% of men experienced contact sexual violence, physical violence and/or stalking by an intimate partner and reported an intimate partner violence-related impact during their lifetime. Over 61 million women and 53 million men have experienced phycological aggression by an intimate partner in their lifetime. (Source)
It is a major public health problem in the United States, with a profound impact on health. A patient’s primary care or family physician might be the only safe space where they can engage.
“I do not only rely on the pre-appointment checklist to determine if a patient might be experiencing intimate partner violence,” said Rebecca Lewis, DO, FACOFP, and ACOFP Governor. “I watch for signs, such as a partner accompanying the patient to her appointments and not allowing them to speak.”
Dr. Lewis also shared that she uses the natural discussion on mental health to talk about things at home that might be leading to stress, which allows her to prod for potential abuse, including financial, emotional, and mental, as well as physical.
Many experts and advocates are pushing for routine patient screenings and conversations about relationships, particularly primary care and pre-and post-natal care, because the time around childbirth is a high-risk time for escalating abuse. Dr. Lewis will separate a patient from their partner by saying she needs a urine sample and then speaking to them in the bathroom. This allows her to connect with the patient without raising awareness from the potential abuser.
"If a patient discloses abuse or denies it despite strong evidence otherwise, I offer to work out a plan with them now or in the future,” continued Dr. Lewis. “We also keep an updated list of domestic violence resources in our offices. I have seen some clever ways to hide them – shoe cards and lipstick containers are two of the more interesting ways.” When the patient leaves – whether there was a disclosure or not – keep records, which could be helpful if they decide to leave their partner later and need legal records.
What to do when a patient discloses abuse
An article published in the National Library of Medicine, part of the National Institute of Health, shared this guidance:
Disclosing violence does not necessarily imply that a major change is going to happen. Assessing the survivor's readiness to change is necessary, as physicians can be instrumental in helping the survivor move from one stage to the other toward action. While supporting the patients going through their life, physicians need to recognize that change is a long process, sometimes non-linear, with frequent setbacks.
When the patient discloses abuse, the initial response of the physician is to show empathy (“I am sorry this is happening to you”), acknowledge the difficulty of sharing the information (“this must be hard on you to talk about it”), express validation while alleviating guilt (“no one deserves to be hit or treated badly, it is not your fault”), and offer help and assurance of continuous assistance in the future (“you are not alone in this, we can help you take care of your health and support you while going through this”). When the patient narrates a violent incident, it is better to obtain a behavioral description of what has happened rather than why it happened. Questions about why can feel like judgment or blame.
The AMA offers a great resource to additionally help guide physicians through this difficult patient care: You suspect a patient is being abused. What should you do?
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