a special program of the National Emergency Medicine Association (NEMA)
Transcripts: 485.1 to 485.5
Week: 485.1 Guest: Rose Matricciani Topic: Detecting Domestic Violence - Part One Host: Richard Roeder Producer: Ed Graham
NEMA: This is a five part series with Rose Matricciani, chief operating officer at Med-Chi in Baltimore, Maryland on a manual produced to instruct doctors in the recognition and treatment of domestic violence in their patients.
NEMA: Ms. Matricciani, is there something special about domestic violence or abuse that makes outsiders not want to get involved?
Matricciani: Yes. We see that many of our physicians don't want to get involved in the issue because it raises for them issues of the patients/physician relationship and confidentiality and many times until the physicians are really educated about how they can get involved and not breach that confidentiality, that poses real problems for them.
NEMA: You've created a manual, a comprehensive guide to help physicians recognize and confront domestic abuse when they see evidence of it in their patients but why do they really need that in that it would seem that the medical issues at least would be rather clear-cut anyhow or is this really not about medical issues?
Matricciani: Well, in effect, it is about medical issues. Most of the medical schools do not provide any training for treating domestic violence victims. They do provide training in child abuse issues. Now we're seeing that the medical schools' curriculum are changing to address domestic violence but most of them do not have any sort of curriculum to address it. Furthermore, residency programs do not address the issue of domestic violence and how to prepare your offices and your staff to be open to receiving these patients and to properly treat and refer them.
NEMA: In the introduction to the manual, there is a list of some of the myths of domestic violence. The one I would particularly ask you to discuss is the myth that battered women can and should leave their violent relationships. Would you talk about that.
Matricciani: Yes. There is a myth out there that if someone is battering you, that the only thing that you can and should do is to leave the relationship and that's not always the case. There are various degrees of battering and there are issues related to whether or not that period of time has elapsed where the person has been battered and the couple have gone to separate counseling and so forth. So there are issues where families want to stay together, people do go into treatment, the batterer does go into treatment, the spouse may leave during the acute phase so that they're not being battered but then may want to work on those issues, those marriage issues in order to stay together as a family.
NEMA: In Section 1 of the manual, you define domestic violence. Would you do that for us.
Matricciani: Yes. Domestic violence is known by several other names such as wife abuse, spousal abuse, women abuse or partner abuse. It's violent behavior that's committed by one partner against another and usually in most cases women are the victims.
NEMA: Now in Section 2 of the manual, you talk about what you call "barriers to identification" but not just those of the victim which would be somewhat understandable such as fear or shame or denial or any number of other problems but you talk about physicians' barriers. Would you explain those.
Matricciani: We have noted many barriers that some physicians may have in being able to properly treat battered victims.
NEMA: Join me for part two on domestic violence with Rose Matricciani.
Week: 485.2 Guest: Rose Matricciani Topic: Detecting Domestic Violence - Part Two Host: Richard Roeder Producer: Ed Graham
NEMA: This is part two in a five part series with Rose Matricciani, chief operating officer at Med-Chi in Baltimore, Maryland on a manual produced to instruct doctors in the recognition and treatment of domestic violence in their patients. I asked Ms. Matricciani about what she calls physician barriers to abuse recognition.
Matricciani: We get into physician barriers because of the courses that we provide and training related to the manual deals with concerns the physicians would have and we have noted many barriers that some physicians may have in being able to properly treat battered victims and some of these barriers have to do with not knowing how to intervene or help or even the physician feeling very helpless about what services are available for victims and how to refer these victims to the services. There may be certain concerns that relate to the physician's own personal experiences that they may identify with the situation in some way that may prevent them from effectively treating the victims so we do discuss in the manual some of these barriers.
NEMA: The manual has sections also on "interviewing the patient and clinical findings." Would you talk about the difference in the gathering of this data in a domestic abuse versus a nonabuse-related injury.
Matricciani: Well certainly in an abuse-related injury, we ask the physicians to ask particular questions and then to document very carefully. One of the concerns in an abuse situation is that you're really making a record that may go on to be a record that may have to appear in a court situation so documentation is extremely important, asking the appropriate questions as to who the perpetrator may have been and using the patient's own words is extremely important in these instances.
NEMA: Just sort of on a personal note that you may have run into with physicians, do you find physicians in a great deal of conflict in a situation like this when they perhaps know both parties, the husband and the wife?
Matricciani: Yes. We've seen situations where usually if it's internal medicine or family practice doctors and they have the whole family, that it raises for them some ethical issues as to how to deal with it but I think that the physicians are becoming so acutely aware of the problem and how to address domestic violence issues that they are effectively working within their practices to deal with that. There are several ways that you can deal with it. You can continue to treat the entire family. You can refer the victim to someone else to be treated in order to still remain in that relationship with the family and there are several ways to deal with that situation so for right not we have not seen it as a real barrier to the doctors effectively treating the patients.
NEMA: Another myth that you mentioned in the introduction to the manual - most domestic violence incidents are caused by alcohol or drugs. When did you come to the conclusion that that plays maybe less of a role than was previously believed?
Matricciani: I think if you if you look at the current studies, the current studies focus on the issue of domestic violence and what they talk about when they talk about alcohol and drugs is that yes, in many cases alcohol and drugs play a part but they are not the root cause of the violence.
NEMA: Join me for part three on domestic violence with Rose Matricciani.
Week: 485.3 Guest: Rose Matricciani Topic: Detecting Domestic Violence - Part Three Host: Richard Roeder Producer: Ed Graham
NEMA: This is part three in a five part series on a manual helping doctors recognize domestic violence in their patients. My guest is on of the creators of this manual Rose Matricciani, chief operating officer at Med-Chi in Baltimore, Maryland.
NEMA: Is there a most common root cause in domestic violence?
Matricciani: We find that from the studies that are out there that a common thread that we see are people who have been battered themselves as children, people who have been exposed to violence as children, have a greater incidence of becoming batterers themselves when they grow up.
NEMA: There is another section in the manual called "Intervention." How adequate or inadequate are the mechanisms that are already in place in this country to deal with the intervention into domestic violence, especially if there was a greatly heightened awareness and a lot more people started responding to this, is there enough of a mechanism currently in place to deal with this number of cases?
Matricciani: I think the biggest problem we see and certainly this is a problems that the physicians have recognized is that there aren't enough services to deal with the number of violence cases that we are seeing, that certainly in Maryland many of our shelters are filled, they have to use other services. We still have those types of issues that are very much a concern to providers once they recognize domestic violence.
NEMA: In the part of the manual titled "Legal Considerations," it's stated that a physician is required by law to report child abuse if it is suspected in a patient but not adult domestic abuse. Now obviously there is a serious privacy consideration but in your opinion should this practice be re-examined?
Matricciani: Well it is being re-examined now on the state level in Maryland and one of the most recent initiatives that will be coming out very soon will be a task force that will look at many of the legal issues surrounding domestic violence and the laws. There are states that have laws about reporting domestic violence, Maryland not being one of them. But there are a lot of considerations with regard to that reporting issue and that will be examined at a state level.
NEMA: Historically, one of the things that has been the most difficult in prosecuting cases of domestic violence and I've learned this from discussing it with many police law enforcement people also is that by the time it comes time to either press formal charges or to go to court and follow through, a lot of times the abused party backs off or completely denies the whole situation. Do you believe that that's part of the profile of a person who ends up being an abused person or is this because historically maybe there hasn't been enough structure to support what they're trying to accomplish?
Matricciani: I think there's a lot of issues surrounding it. I think certainly there is a big fear that's related to being a victim and prosecuting that spouse. I think there's also the issues related to being very dependent on that spouse. Most of these victims are extremely dependent for their livelihood. Very often they've been isolated from family and friends. This is all part of that control mechanism that the batterer has over the victim so there's a lot of issues for the victim that are just part of all the things that the victim has been subjected to that make it very difficult for the victim to want to go and testify against that batterer.
NEMA: Join me for part four on domestic violence with Rose Matricciani.
Week: 485.4 Guest: Rose Matricciani Topic: Detecting Domestic Violence - Part Four Host: Richard Roeder Producer: Ed Graham
NEMA: This is part four in a five part series on a manual designed to teach physicians about domestic violence in their patients. My guest is one of the creators of this manual, Rose Matricciani, chief operating officer at Med-Chi in Baltimore, Maryland.
Matricciani: There's a lot of issues for the victim that are just part of all the things that the victim has been subjected to that make it very difficult for the victim to want to go and testify against that batterer.
NEMA: Statistics certainly support the notion that a woman is at her greatest risks when she tries to escape an abuser. Is that not correct?
NEMA: Talk about that a little bit both in terms of what degree that threat really exists and also what can be done to mitigate that to some degree.
Matricciani: Certainly we have seen numerous court cases where victims have been killed because they have tried to get away from their abuser and we have seen more and more stalking incidents as victims have tried to get away and we see more cases where women have gone underground because of the very serious threats that they have to life, limb and to the lives of their children that they are extremely fearful. So these cases are very very well documented now and it is a concern for everyone within the system of how to properly be able to protect these women and that's one of the reasons that your shelters are not publicized and their locations known about so that they can provide this sense of security.
NEMA: Have you seen any kind of a struggle inside the law enforcement community about how to both protect someone but then to have to deal with this issue that if there has not been an actual physical assault even though the threat may be fully in the environment, until some actual crime has been committed they seem to have their hands tied as far as responding to the situation.
Matricciani: I think that's true and I think that's one of the problems that the law enforcement agencies have difficulty dealing with and that is that until something such as an assault has been committed, their hands really are tied with regard to responding to domestic disputes.
NEMA: Now with your manual - again you're basically trying to help doctors be more fully equipped to deal with domestic abuse, to recognize it and to respond to it - what about the issue of an intervening doctor and the heightened responsibility of legal entanglements and court testimony and this is very frequently no doubt among doctors who are overwhelmed and swamped by the amount of patient load they have already.
Matricciani: We haven't seen resistance. We've now provided training based on the manual in just about every hospital across the state of Maryland. We've trained over 1500 health care providers and we've talked about the issues related to and it does take more time to interview these people and to be very thoughtful in referrals and getting them help but we've seen a real positive response by the medical community to want to address this issue as another issue of violence in our community and we've seen a very positive response by linking the medical community in with the community groups so that it's a joint concerted effort of everyone being responsible for their piece of it, if you will and so we have found that our doctors have been extremely responsive and wanting to be a part of this and to make things better.
NEMA: Join me for part five on domestic violence with Rose Matricciani.
Week: 485.5 Guest: Rose Matricciani Topic: Detecting Domestic Violence - Part Five Host: Richard Roeder Producer: Ed Graham
NEMA: This is part five in a five part series with Rose Matricciani, chief operating officer at Med-Chi in Baltimore, Maryland on a manual produced to instruct doctors in the recognition and treatment of domestic violence in their patients.
NEMA: After studying the manual which I thought was very impressive by the way, it seems to me that this would be perfect for the general public even in its exact form that exists right now, not just for physicians. Have you ever considered making it available more universally?
Matricciani: We have had calls from the general public for the manual and we have sent it out. The only thing is that we produce the manual, we produced approximately 7,000 editions of the manual free of charge to our physicians because we were able to underwrite it with grant money. Now we have a charge of $10 for the manual and the inserts that go with it but it has been made available to the public and the public who has requested it. If we've had a call from someone from the general public who hasn't had the money or been able to pay for it, we have still made the manual available to them because we think it's so very important for them to be able to have the information.
NEMA: And how long has it been that that the manual has actually been in print?
Matricciani: The manual has been out now I think since May of 1994.
NEMA: And what kind of remarks or feedback have you gotten from physicians who have either read the manual or that you've done training with?
Matricciani: We've gotten very positive feedback. We have evaluations that we do in all of our training's and it's been extremely positive by the physicians, the nurses, the social workers and the other health care providers who have attended it. We've gotten very positive feedback about the materials we produce, not only the manual but the victim brochures that we have made available.
NEMA: Talk about the card that you have that goes in a physician's office to try to encourage people to talk to their doctor about violence.
Matricciani: We produced a little tent card as part of our entire campaign against family violence which basically says "talk to your doctor about family violence" and some of the trigger words on it are "feeling alone and afraid," "feeling hurt and scared," and our logo is "unlock the silence, trust is the key." And we ask the doctors to put it out in their office areas and we've asked the hospitals to put it in their clinic areas so that these victims see that someone really is concerned about them and that they have someone who is attuned to this problem and that they can open up to and to speak to. Part of the problem is getting the patient to initially talk about the situation.
NEMA: What do you think the future of this science is? Where does it seem to be headed? Is it headed in the prevention direction, in the intervention direction, all of the above? Something else?
Matricciani: I thing certainly we're trying to focus in the prevention direction. We're trying to look at getting children and talking to children at that age level when they're very young and talking to them about how to handle their anger, how to deal with their anger and the proper way that they need to deal with their anger so that they don't think that it's okay to hit someone when you're mad and angry or they don't think it's okay to just punch on somebody so I think what we're saying is trying to get youngsters at a very early age and really focus on the prevention aspect. It's much harder once someone has been exposed to violence and has become a batterer to then treat them.