Do ask, do tell about intimate partner violence
May 7th, 2012
05:01 PM ET

Do ask, do tell about intimate partner violence

Editor's note: Dr. Sharon Horesh Bergquist is an assistant professor of medicine at Emory University School of Medicine in Atlanta, Georgia. As a practicing internal medicine physician, she encounters patients who are dealing with intimate partner violence, which can have serious health effects.

As a physician, I look to evidence-based guidelines to drive my medical decisions. Yet often there isn't a consensus - such as whether doctors should ask patients if their partner is being violent with them in any way (physically, sexually or emotionally).

The most recent recommendation issued by the United States Preventive Services Task Force in 2004 did not find sufficient evidence to support screening women for partner violence.  However, many professional organizations such as the American Congress of Obstetricians and Gynecologists, the American Medical Association and the Institute of Medicine support such screening.  

A study published on Monday in the journal Annals of Internal Medicine  comprehensively reviews the studies published since 2003 on the effectiveness of screening and interventions in reducing partner violence and its related health outcomes.

An estimated 5.3 million American women each year are the victims of partner violence, according to the report.  The prevalence certainly suggests that as physicians we have a unique opportunity, and arguably responsibility, to create a trusting environment to counter the feelings of self-blame, isolation and shame that many who are victims of partner violence experience.

However the basic tenet, "Do no harm," should apply to partner violence just as much as any other health care intervention. The Annals article points out that some women who are screened for partner violence may feel a loss of privacy, emotional distress, and concern about further abuse. Yet these adverse effects were minimal in the 14 studies that were reviewed.

Does the benefit of screening outweigh this potential harm?  In the one large randomized controlled trial reviewed, screening opened the door to a 36% increase of women who discussed abuse with their physician.  But there was no statistically significant difference between the two groups when it to came to reduced recurrence of violence, mental health and quality of life.

Still, caution should be exercised when interpreting this lack of statistical significance. Randomized controlled trials are inherently difficult to conduct on partner violence since simply being in such a study increases self-awareness that may affect behavior. Plus, true "blinding" - the gold standard of clinical trials - isn't possible in this situation, and ethical considerations require that interventions be offered to control groups of non-screened women.

When it comes to partner violence, perhaps the better question to ask ourselves is: How much convincing evidence do we need?  In the above trial, women in the screened and usual care groups both had reduced recurrence of violence and better health outcomes.

From another standpoint, the overwhelming majority of those women screened favored being asked. And I, like many physicians, feel I should do a better job asking. Yet time constraints, lack of adequate training and limited knowledge about resources often get in the way.

For health care to be effective at helping people who are victims of partner violence, we need a systematic, standardized approach to screening and well thought-out protocols on how best to intervene.

And men aren't exempt. While this new study did not look at male victims, a recent CDC study found "1 in 10 men in the U.S. have experienced rape, physical violence, and/or stalking by a partner with IPV-related impact."

In our office, we use a screening questionnaire during routine wellness visits to inquire about partner violence. Can I say that all my patients who are victims of abuse answer it truthfully? Knowing the psychological readiness it takes to break the cycle of violence, I doubt it.

I can say that for at least some (female and male patients), asking those questions opened the window to more services, more accurate diagnosis of chronic issues, and better management of their health.

There are still several steps ahead before the USPSTF issues a new final recommendation for doctors.  Check back with CNN.com/health for more on this issue.

soundoff (27 Responses)
  1. Mike

    I grew up in a home where violence was prevalent. Mom, unbeknownst to us was addicted to medication. I think you have to ask yourself a very simple question when it comes to drug dealing doctors. Why would you say anything to a group of people whose names are now put into databases because they like to poison everyone like "rabid monkeys".

    May 8, 2012 at 08:59 | Report abuse | Reply
  2. David

    That tin foil hat is a little tight there, Mike. Do the orderlies know you're on the computer again?

    May 8, 2012 at 11:15 | Report abuse | Reply
    • Mike

      David, just stating the facts. Doctors are nothing more than poisoners. They were that way in Germany, they're that way in America. Why do you think societies hang them?

      May 8, 2012 at 22:37 | Report abuse |
  3. john

    well some like the violence, some thinks it is normal, some wants it to stop if you want it to stop pick up a big stick and do what needs to be done sometimes a good defense is a good offense worked with me in my last relationship

    May 8, 2012 at 16:27 | Report abuse | Reply
  4. MashaSobaka

    Is there *really* any harm in being asked about domestic violence and/or abuse? If you're not experiencing abuse, you can answer "No" and just add it to the list of seemingly-invasive questions that doctors already ask. If you are, it gives you a chance to open up and lets you know that there might actually be someone on the face of the planet who is interested in knowing if you are being abused. Where's the harm? It's a serious issue. It's getting more serious by the day. Doctors need to step up.

    May 8, 2012 at 17:14 | Report abuse | Reply
  5. Ann Wilson

    It might be a good idea to put this question on the questionnaire's a new doctor gives you. As women are referred
    to specialists all the time and if every doctor had that question on the forms to fill out, maybe the women would
    start to think about their situation. Just have the question, are you experiencing domestic violence, along with
    do you have high blood pressure, etc.

    May 8, 2012 at 20:40 | Report abuse | Reply
  6. lucullus

    I'm surprised to hear that only women suffer from domestic violence. Fascinating.

    May 8, 2012 at 21:46 | Report abuse | Reply
  7. BeenThereToo

    The CDC study referenced indicates that 1 in 10 men studied reports: emotional-physical-other violence (from their partner?) – I-ll bet that the true percentage of abused men is Far Higher! (most men don't talk or admit it).
    Comments welcomed! Peace-

    May 9, 2012 at 09:52 | Report abuse | Reply
  8. t3chsupport

    When I was a child, my mom went from abusive relationship to abusive relationship. I was always so stressed out that I was constantly sick, and almost didn't pass the third grade because of it. Looking back, I know my teachers knew something, and they would ask me, 'is everything alright at home?'. I didn't know anything different, so I always said yes. Their questions were not specific enough, and I didn't know how to answer, or that I could get help.

    Any woman who puts their children through that kind of torment is no real mother. If it's not out of fear or weakness, then it's out of selfishness or vanity, thinking that they can change this monster if they just love them enough, and 'he's usually so nice' type crap. A real mother's main goal in life is protecting their children, and staying with an abuser is exactly the opposite. Even if they never abuse the kids, they're still seeing it, and it still has an effect. Your boys will grow up thinking it's normal to hit their wives. Your girls will grow up thinking it's normal to be hurt if she does something 'wrong'. If not, they'll both grow up knowing that you were a weakling, and that you did not care enough about them or yourself to get out of a dangerous situation. Today I have tried to forgive my mother as much as I can for what she dragged us through, but I'll never respect her the way people expect to respect their parents.

    Yeah, it may be hard to get out, but NO ONE will do it for you.

    Anyone who purposely abuses their loved ones needs to be put into the ground, without exception. That's the value I have for humanity now that I've been subjected to the worst of it. Those 'people' have no value.

    May 9, 2012 at 10:32 | Report abuse | Reply
  9. t3chsupport

    Asking someone if they are being abused would not work. You would have to adapt the language.
    "Does anyone at home ever make you feel afraid?"
    "Does anyone at home ever physically hurt you?"
    "Does anyone at home ever make you feel bad?" (that one would need some work obviously).
    Depending on the answers there, more questions could be raised.

    Just asking them if they are being abused won't get you much. They will usually say no, because it's what they're either programmed to do at that point, are afraid of telling anyone about the 'A' word, or they don't know that what is happening to them is abuse.

    May 9, 2012 at 10:37 | Report abuse | Reply
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