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Discussing Domestic Violence with Family Practice Patients

Am Fam Physician. 2002 Apr 15;65(8):1645-1646.

Surveys from several countries report that 5 to 20 percent of women attending primary care practices have experienced domestic violence, but few have discussed the problem with their physician. Studies in Ireland by Bradley and associates and in England by Richardson and colleagues attempted to clarify the prevalence of domestic violence in patients attending family practices to identify related factors and risks.

Bradley and associates asked clinic receptionists to give a questionnaire and an information packet about domestic violence to consecutive female patients attending 22 general practices during a two-week period. Useable data were returned from 1,692 women who were currently or had recently been in an intimate relationship. The women ranged from 16 to 84 years of age (median: 35 years), and 45 percent (n = 753) were entitled to free care because of poverty. Violence from a partner was reported by 39 percent of the respondents. Of these women, 24 percent (n= 158) reported experiencing only one form of violence, while 51 percent (n = 330) reported at least four types of violent attacks. The most common forms of violence included pushing, grabbing, shoving, shouting, and threatening. About 300 women reported physical injury caused by punching, kicking, or choking, and about 10 percent reported forced sexual intercourse. Although only 5 percent of the women reported that a physician had ever asked about domestic violence, 78 percent reported that this questioning would be acceptable.

In the survey from Richardson and colleagues, research assistants gave surveys to women in the waiting areas of 13 general practices in an inner city area. Overall, 74 percent of the women surveyed had experienced controlling behavior from a partner, and 41 percent reported experiencing physical violence from a partner. Of the 21 percent of women who sustained injuries, about 50 percent had sought medical attention, and 32 percent had informed their physicians about the abuse. One fourth of abused women reported exacerbation of abuse during pregnancy. Physical abuse was significantly associated with divorce, separation, and unemployment status. Only 4 percent of the women recalled ever being asked by a physician about domestic violence, but 80 percent reported that they would not mind being asked. The majority of the women said that they would be more comfortable discussing domestic abuse with a female physician.

Both studies conclude that domestic violence is common among patients attending family practices, but the situation is frequently unrecognized. Violence may take many forms, resulting in a variety of outcomes, but it is almost always associated with fear. About 80 percent of women approve of routine questioning by physicians about domestic violence.

Bradley F, et al. Reported frequency of domestic violence: cross sectional survey of women attending general practice. BMJ February 2, 2002;324:271–4, and Richardson J, et al. Identifying domestic violence: cross sectional study in primary care. BMJ February 2,2002;324:274–7.

editor's note: Studies of American populations offer similar results—up to 40 percent of women experience violence from a partner. A review in an upcoming AAFP Home Study Monograph emphasizes that there is no typical “victim profile” for domestic abuse (Choby E. Midlife healthcare for women. AAFP Home Study Self-Assessment Monograph 2002 No. 278 [In press].) According to the monograph, domestic abuse can only be identified by physicians who ask the right questions and create a climate of safety in which victims feel able to address these issues. The monograph includes screening questions, suggestions for intervention, and resources for families.—a.d.w.

 

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