Integrating Routine Inquiry about Domestic Violence into Daily Practice

Domestic violence terrorizes the lives and damages the health of millions of women each year (1, 2). Studies indicate that 21% to 54% of women seen in emergency departments or primary care clinics have reported physical or emotional abuse by a partner in adulthood and at least one in three have experienced some form of abuse during their lives (3-5). Research over the past two decades has continued to document the profound effects of domestic violence on women's health (6-10). For many victims, the health care setting is the only place they will seek help, and health care providers play a critical role in creating a safe atmosphere for patients to discuss the abuse that they have experienced.

Most Americans feel that, if asked, they could talk to a physician about domestic violence, and more than half feel that physicians could help in such situations (11). However, battered women identify medical providers as being among the least effective professional sources of help. Rodriguez and colleagues (12) asked formerly battered women about their experiences with the health care system. These women reported that disclosure was difficult, in part because of the clinician's failure to ask about battering during the medical interview. Over three quarters of the cohort favored direct inquiry about domestic violence as a routine component of the clinical encounter.

New guidelines have evolved to address domestic violence within the health care setting. The …