Health care providers may see other indications of violence, particularly evidence that the patient's intimate partner is controlling. The patient may allow her husband or partner to speak for her; her partner may insist on accompanying her at all times and on answering all questions. The patient may miss appointments (perhaps due to lack of transportation or telephone), or indicate an inability to obtain medication.
Routine screening questions can be included in the written or oral questions asked of all patients. These questions do not need to be extensive or intrusive; one question might be, for example: "Are you currently in a relationship in which you are being hurt, threatened, or made to feel afraid?" It is useful to frame these questions with a sentence that indicates that all patients are asked about violence. This may help to counter a patient's fear that she is being singled out or has somehow indicated that she experiences violence in her life. These questions also help to raise awareness of and to destigmatize the issue of domestic violence.
If health care providers see signs of abuse, or if the patient answers yes to routine screening questions, they can ask additional questions to determine if there is a pattern of violence in the patient's life. It is critical that this discussion take place in private.
If a health care provider determines that violence may be an issue for the patient, she can offer to direct the patient to additional resources. Helping to make the patient aware of the existence of such resources, or even to articulate domestic violence as a concern, can provide the woman with the some of the support and information she may need in making informed decisions. Health care providers can also do a basic lethality assessment by asking whether the patient feels that she is in immediate danger, whether weapons were involved in the incident that caused the injury, whether her partner has threatened to kill her or commit suicide, and whether the abuse is getting worse.
The World Health Organization, in its Violence Against Women: What health workers can do, also recommends that doctors should not prescribe mood altering drugs, since these may reduce a woman's ability to protect herself in the case of an attack.
Adapted from Elaine J. Alpert & Cheryl L. Albright, , Hippocrates, Domestic Violence, Hippocrates, vol. 14 (2000); Janet Nudelman & Helen Rodriguez Trias, Building Bridges Between Domestic Violence Advocates and Health Care Providers (1999).
The FVPF offers comprehensive model screening guidelines and useful recommendations on how screening should occur in different kinds of health care contexts in its publication, Preventing Domestic Violence: Clinical Guidelines on Routine Screening (1999). The SANE-SART programs (Sexual Abuse Nurse Examiners and Sexual Abuse Response Teams), described more fully in the section on sexual assault, provide useful models for working with and treating sexual abuse survivors in a health care setting.
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