How Physicians Identify Victims of Domestic Violence

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The summary below is from the full report titled "A Qualitative Analysis of How Physicians with Expertise in Domestic Violence Approach the Identification of Victims." It is in the 19 October 1999 issue of Annals of Internal Medicine (volume 131, pages 578-584). The authors are B. Gerbert, N. Caspers, A. Bronstone, J. Moe, and P. Abercrombie.

What is the problem and what is known about it so far?

Unfortunately, domestic violence (physical abuse by family members or domestic partners) is a common problem. Domestic violence can have bad effects on physical and psychological health. Yet persons who are abused often do not tell their doctors about it because they are afraid, embarrassed, do not think of it as a health problem, or do not think doctors would be able to help them. Also, many doctors do not ask about this problem because they forget, find the subject is uncomfortable, or believe that there is little they can do to help an abused patient.

Why did the researchers do this particular study?

The researchers wanted to find out how doctors who are experts in taking care of domestic violence patients approach the subject with their own patients.

Who was studied?

Forty-five doctors in San Francisco who had frequently identified and cared for abused patients. These doctors were emergency room doctors, primary care doctors, or obstetrician/gynecologists.

How was the study done?

The researchers got together 6 groups of these doctors (6-11 doctors in each group) to talk about domestic violence. Two of the researchers moderated each group by using a guidebook that included a standard set of questions about talking to patients about domestic violence. The moderators asked each group to discuss the same set of questions. The researchers taped each of the 6 group discussions, which lasted about 90 minutes each. The researchers then listened to the tapes to identify topics that commonly came up in all of the discussions.

What did the researchers find?

The discussions revealed five main themes. First, the doctors worded questions about abuse in ways that tried to make the patient comfortable. Second, there were certain signs that reminded the doctors to talk about abuse. Third, the doctors often were able to get a patient to talk about abuse after a number of visits, as the patient came to trust the doctor. Fourth, the doctors agreed that it was uncommon for patients to tell a doctor about abuse without the doctor bringing up the subject. Fifth, the doctors believed that even just getting the patient to talk about the abuse could be helpful to the patient. Also, the doctors were afraid that new laws in some states that would require doctors to report all cases of abuse to the police might further discourage doctors from asking and patients from telling.

What were the limitations of the study?

This study included only 45 doctors in a single city. Other types of doctors or doctors practicing in other places may approach domestic violence differently. Also, the researchers only asked doctors to say what they did. They did not observe what the doctors actually did with their patients.

What are the implications of the study?

Even doctors with experience with abused patients can find it difficult to identify patients who have this problem. However, this study reports some of the things that doctors can do to try to find out if their patients are victims of domestic violence.