A Qualitative Analysis of How Physicians with Expertise in Domestic Violence Approach the Identification of Victims

19 October 1999 | Volume 131 Issue 8 | Pages 578-584

Background: Physicians have been called upon to identify victims of domestic violence, but few studies provide insight into how physicians can navigate around the barriers to identification.

Objective: To describe how physicians who are committed to helping battered patients identify victims of domestic violence in health care encounters.

Design: Six focus groups were conducted.

Setting: Focus group research facilities.

Participants: 45 emergency department, obstetrician/gynecologist, and primary care physicians in the San Francisco Bay Area who identify and intervene with victims of domestic violence.

Measurements: Through constant comparison, a template of open codes was constructed to identify themes that emerged from the data. Data were analyzed according to the conventions of qualitative research.

Results: The data revealed five major themes: 1) how physicians framed screening questions to reduce patient discomfort; 2) patient signs that "switched on a light bulb" for physicians to suspect abuse; 3) direct and indirect approaches to identification, with an emphasis on facilitating patient trust and disclosure over time; 4) the rarity of direct patient disclosure; and 5) how physicians redefined successful outcomes of universal screening. Physicians also described two new barriers to screening: mandatory reporting and "burnout" due to lack of direct disclosure.

Conclusions: Identifying domestic abuse is difficult even for physicians committed to helping victims. Physician reports illustrate the need to frame questions and develop indirect approaches that foster patient trust. Given the many barriers to screening and the rarity of direct patient disclosure, it may be more productive to redefine the goals of universal screening so that compassionate asking in and of itself constitutes the first step in helping battered patients.

Author and Article Information

From the University of California, San Francisco, San Francisco, California.

Grant Support: By National Institute of Mental Health grant 1 R01 MH51580.

Acknowledgments: The authors thank the physicians who participated in the focus groups and those who participated in reviewing the study findings. They also thank Stephanie Greer and Survey Research Group for assistance in recruiting physician participants and organizing the focus groups; Candace Love, PhD, and Richard Carlton, MPH, for assisting the authors with moderating focus groups; and Jennifer Fechner, BA, for transcribing the focus group audiotapes and proofreading the manuscript.

Requests for Reprints: Barbara Gerbert, PhD, Division of Behavioral Sciences, University of California, San Francisco, 601 Montgomery Street, Suite 810, San Francisco, CA 94111; e-mail, gerbert{at}itsa.ucsf.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Drs. Gerbert, Bronstone, Moe, and Abercrombie and Ms. Caspers: Division of Behavioral Sciences, University of California San Francisco, 601 Montgomery Street, Suite 810, San Francisco, CA 94111.