Dear Dr. Roach: Having recently changed doctors (due to a move), I filled out a new-patient intake. It had this question: 鈥淒o you feel safe in your home?鈥� It seemed like a question that might evoke a response for a lot of possible issues that could make a person feel unsafe. I鈥檓 pleased to know that my new doctor cares about the safety of her patients, but what if a patient is not ready to divulge an unsafe situation, such as domestic violence?
G.G.B.
Domestic violence, also called intimate partner violence, affects both women and men, but women are much, much more likely to be injured or killed by partner violence than men are. Intimate partner violence can happen in any socioeconomic, ethnic or age group, and it can be very hard to diagnose. Physicians are in a good position to intervene, but we often do not ask and do not recognize the symptoms or physical signs of a person in an abusive relationship. I agree with routinely asking patients about domestic violence, and including these issues on a questionnaire (verbally, electronic or on paper) is a good way to screen for it. I am in the habit now of telling all new patients that I ask about partner violence since I have seen so many cases. Of course, the patient must be alone with his or her doctor when this is asked.
A person who is in an abusive relationship might not be ready to disclose that fact to the doctor, and there are many potential reasons for this.
There have been times when I have asked that question of a patient and despite hearing a 鈥渘o鈥� answer, still suspected there might be an issue. In that case, I tell the patient that if she or he ever wants to talk more about it, I am available to speak with, and will make a note to ask again on subsequent visits. I have had patients come back to tell me that there was abuse even the first time I asked, but they weren鈥檛 ready to discuss it (the first time you meet a new doctor, it鈥檚 hard to trust; also, many people who are abused blame themselves, think the abuse will stop or do not know that the doctor has resources available to help). Some doctors worry that their patients will be angry or embarrassed at being asked: That almost never has been my experience.
When I do see someone who admits to being in an abusive relationship, I assure the patient that I am there to help, and that his or her safety is my goal. I convey that I know it can be hard to admit the abuse.
I recognize that her or his situation is complex and that well-meaning advice to immediately leave may not be possible or may make the situation worse, so I avoid doing so except in very rare situations. I am fortunate to have an experienced social worker in my office who has dealt with many such situations and knows what services are available. There also are a variety of community resources for women to discuss their options, and our office keeps a list.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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