Courtesy of the Texas Medical Association
A far cry from “open wide and say ‘ahhhh,’” physicians are urged to ask patients, “Do you feel safe in your home?” Doing so might identify victims of domestic violence and bring aid to the victims.
Texas law requires doctors to provide information about safety and shelter to patients with injuries that might be the result of family violence. The law also says the physician should document this type of discussion in the patient’s medical record. Physician experts urge colleagues to mention the sensitive subject in typical patient visits, in hopes of helping patients through a difficult situation.
“The overall national incidence rates of domestic violence are falling, yet the Texas rates are rising and are now twice the national average,” writes Rita E. Schindeler-Trachta, DO, and F. David Schneider, MD, MSPH, both Texas Medical Association (TMA) physician leaders.
“Domestic violence, now termed intimate-partner violence (IPV), affects men and women of all ages, races and socioeconomic strata.” Dr. Schindeler-Trachta is founder and owner of Austin Family Medical Clinic in Austin and a board member of the Women's Advocacy Project, and Dr. Schneider is professor and vice chair in the Department of Family and Community Medicine at The University of Texas Health Science Center at San Antonio and founding president of the Academy on Violence and Abuse.
The physicians’ journal article urges physician colleagues to use their unique diagnostic skills to help identify and aid victims of IPV. “Our best hope to aid in breaking the cycle of violence is to actively screen and distribute safety information to our patients,” the article declares.
Because patients trust their physicians, they often will divulge fears, threats and actual events of domestic violence to their doctors.
Most any physician may encounter a patient who is an IPV victim, though the symptoms may not be readily apparent. “While some victims come in with the obvious broken bones and contusions, many others have vague, nonspecific complaints for which domestic violence needs to be considered in the differential diagnosis,” the article says.
One physician describes a chilling account of a patient visit: “Her estranged husband, recently released from jail, broke into the house. After forcing her to have intercourse, despite her protests, he took the broken window glass, cut himself, and deliberately bled into her eyes. He told her he wanted her to get his hepatitis C.
Despite all this, her initial complaint when she visited my office was ‘hair loss.’”
Physicians can then assist the victim, including referring her or him to a shelter.
Texas has seen an 18 percent increase in the incidence of domestic violence in the past 10 years, though the nationwide rate has declined by 61 percent. Both women and men can be IPV victims. Each year as many as 1.5 million women and 800,000 men are victimized.
“We can increase public awareness, treat domestic violence as a disease and employ preventive and transmission-reduction strategies,” the physicians reason. “In so doing, we stand a better chance of breaking the cycle of abuse, reducing domestic violence, creating improved behavior models for tension and conflict resolution for ourselves and our children and, as a result, reducing the transmission of domestic violence to the next generation.”
The journal article appears in the January issue of Texas Medicine magazine, the official publication of TMA.
TMA is the largest state medical society in the nation, representing more than 41,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
