To the Editor: The coronavirus disease 2019 (COVID-19) pandemic is exacerbating domestic violence in the United States. The term domestic abuse encompasses different forms of abuse, including intimate partner violence (IPV). In the United States, one in four women and one in 10 men experience some form of IPV.1 These rates are expected to increase in response to social distancing measures because survivors are isolated with their perpetrator for longer periods of time. In March, U.S. police departments reported an increase in domestic violence calls as high as 27% after stay-at-home orders were implemented.2 We are writing to offer suggestions on how family physicians can mitigate this urgent issue during telemedicine visits.
Screen every patient for IPV. The U.S. Preventive Services Task Force recommends screening all women of childbearing age for IPV. There are limited data on screening for IPV in men.3 Examples of screening tools for IPV are available in a previous American Family Physician article.4 Dialogue should begin by asking if the patient feels safe and valued in their relationship.4 When video is available, physicians should recognize nonverbal indicators of abuse, such as avoidance of eye contact or suspicious injuries on the head, neck, or forearms. During telephone visits, physicians should be sensitive to the patient's tone of voice because minimizing injuries and seeming fearful or evasive are other indictors of abuse.
Prioritize the patient's privacy. Screen for IPV without the patient's partner or children present, and reassure patients of their confidentiality rights.4 Identify the preferred method of communication before the telemedicine visit. Confirm if the patient can speak privately and safely. Some perpetrators monitor personal accounts, phone calls, or internet history.1 Physicians should teach patients how to clear their internet and phone histories if requested.
Use alternative methods of communication if needed. If a patient cannot speak openly during a telemedicine visit, ask only yes or no questions. The STAT (Slapped, Threatened, and Throw) screening tool exclusively uses yes or no questions. Consider nonverbal modes of communication, such as messaging through the health system's electronic portal. Physicians can direct patients to a safe chat room of the National Domestic Violence Hotline at https://thehotline.org. Patients can also text “HOME” to 741741 to communicate directly with a trained counselor from the Crisis Text Line. If there is immediate danger, advise patients to call 911.
Refer patients who screen positive for IPV to community resources. Referral to community resources can reduce psychological harms from IPV.5 Physicians can search for local shelters at https://www.domesticshelters.org, for resources by state at https://www.womenshealth.gov/relationships-and-safety/get-help/state-resources, and for resources to use during COVID-19 at https://www.futureswithoutviolence.org/get-updates-information-covid-19/.