In a study of how physicians helped victims of domestic violence, UC San Francisco researchers found physicians who provided validation -- acknowledged that the abuse had occurred and confirmed the patient's worth -- had a positive impact on patients who had been abused.
The study found validating messages such as "battering is wrong" and "you deserve better treatment" not only provided relief and comfort to women, but also helped them realize the seriousness of their situation and helped them move toward safety. Those messages were effective even if women didn't disclose directly to physicians that they had been abused.
"Physicians often don't intervene with victims of domestic violence because abuse is hard to talk about or because they don't believe that they can help," said Barbara Gerbert, Ph.D., UCSF professor and chair of the division of behavioral sciences, department of dental public health and hygiene in the UCSF School of Dentistry. "This study shows that physicians don't have to know for sure if the patient's underlying health problems are caused by abuse to help them."
The study, published in the summer issue of Women & Health, describes from the perspective of domestic violence survivors how physicians helped the women improve their situation and thus, their health.
Gerbert and co-researchers interviewed 25 Bay Area women who had been in a physically abusive relationship with an intimate partner and who had a positive health care encounter with a physician.
Study findings show women and physicians often sidestepped or "danced around" talking about the abuse, said Gerbert. Physicians and patients demonstrated a variety of behaviors during health care interactions. In some instances physicians asked directly about the abuse and patients directly disclosed. In most cases, physicians either probed about the abuse, dropped hints, or ignored or failed to recognize signs of abuse while patients either dropped hints of abuse, lied, changed their story, or minimized the abuse.
Researchers described these complex interactions as the "dance of disclosure and identification."
The researchers also found that regardless of whether the abuse had been directly identified, more than half (16) of the women described how validation from physicians led to turning points which changed how they thought about themselves or their situation.
Gerbert and researchers suggest if physicians suspect domestic violence, they should not depend on direct disclosure from the patient. Rather, physicians should participate in the "dance" and validate the individual's human worth. After validating the patient's situation and value, the researchers suggest that health care providers document the abuse, and, if possible, help the patient move to a safe environment or in other ways plan for safety.
Co-authors of the study are Priscilla Abercrombie, RN, NP, PhD, assistant clinical professor, UCSF School of Nursing; Nona Caspers, MFA, senior editor, division of behavioral sciences, UCSF School of Dentistry; Candace Love, PhD, research associate, division of behavioral sciences, UCSF School of Dentistry; Amy Bronstone, Ph.D., research associate, division of behavioral sciences, UCSF School of Dentistry.
The study was funded by the National Institute of Mental Health.
Journal
Women & Health