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Screening for Family Violence: What's an Evidence-Based Doctor To Do?
It was simply a matter of time before someone would attempt to apply the medical and public health screening paradigm to family violence. After all, it appears to be quite a natural fit on the face of it. Family violence in all its pernicious forms is prevalent (1) and certainly erodes quality of life (2). Perpetrators of family violence often isolate their victims from individuals who can help (3), potentially placing the primary care physician in the unique position of being the only one capable of identifying an abusive situation outside the abuser–victim dyad. In addition, over the past 2 decades, doctors have been asked to take up the public health gauntlet for any number of quasi-medical causes in their increasingly cramped primary care visit, ranging from gun ownership to seat belt use. Stemming incipient domestic violence with a screening strategy would seem as good an opportunity to heal as one gets, especially for a profession that seeks to meld science and art in the service of humanity.
Unfortunately, investigators seeking the colonoscopic equivalent of a domestic abuse screening test may well be on a fool's errand. Subclinical diseases such as cancer and atherosclerosis are not like family violence. Patients typically come for screening tests in …
