Detecting Domestic Violence

Domestic violence remains one of the more difficult issues for the medical community to address, in part because it sits at the intersection of a patient’s physical health and a deeply private, often dangerous home situation.

Physicians have historically received little formal training in recognizing the signs of domestic abuse or in how to raise the subject with a patient without breaching trust or making a dangerous situation worse. That’s slowly changing, as more medical schools and continuing education programs build domestic violence recognition into their curriculum.

A few myths tend to get in the way of effective intervention. One is the assumption that a person being abused can simply choose to leave — in reality, leaving an abusive relationship is often the most dangerous moment for a victim, and the barriers to leaving (financial dependence, fear, isolation from family and friends) are significant and real. Another myth is that alcohol or drugs are the root cause of domestic violence; substance use is frequently present, but it isn’t the underlying driver.

Careful documentation matters enormously, both for the patient’s ongoing care and because that documentation may end up supporting a legal case down the road. Asking direct, non-judgmental questions, using the patient’s own words, and knowing what local resources and shelters are available are all things a healthcare provider can do to make a real difference.

NEMA supports efforts to improve how the medical community recognizes and responds to domestic violence, since a healthcare visit is often one of the few opportunities to intervene.