Physicians who compassionately ask patients if they are being physically abused can provide the first step in helping battered victims get the help they need, according to a UC San Francisco study.
The study looked at techniques physicians used to identify victims of domestic violence. It found that compassionate asking--not necessarily getting a yes or no answer immediately--can help domestic violence victims find a way out of their situations.
"A yes response from a patient should not be the goal of the physician because there are so many reasons for a victim not to disclose the information," said Barbara Gerbert, PhD, UCSF professor and chair of the division of behavioral sciences, department of dental public health and hygiene in the UCSF School of Dentistry. "And it's frustrating for physicians if the goal is to get a yes answer. So what we found from these successful physicians is that they realized that it's their job to ask in a validating way that's non- judgmental and gentle, and in a way that let's the woman tell her story if she wants to."
This process, Gerbert said, can plant a seed in victims.
"In a previous study we had done with survivors of domestic violence, we found that they remembered physicians asking in a gentle way and often held that with them," Gerbert said. "They found it useful in helping them move toward safety."
The study, published in the October 19 issue of the Annals of Internal Medicine, described some of the barriers physicians face in identifying victims of domestic violence, such as a reluctance on the victim's part to disclose this kind of information because she feels afraid or ashamed. "That's another reason asking in a non-judgemental way is helpful." Gerbert said "For physician to ask and say 'no one deserves to be hit' is an empowering statement."
Gerbert and co-researchers interviewed 45 physicians in the San Francisco Bay Area who had expertise in identifying victims of domestic violence. The study found that physicians who screen for domestic violence incorporate the questions into routine health histories, thus normalizing the issue and reducing patients' discomfort. Some physicians also broached the subject indirectly by asking patients questions such as how their home and work situations were and if they were experiencing any stresses they want to talk about. Others probed over a series of visits or talked about domestic violence in general terms, educating the patient on how large of a problem it is in society.
The study found that:
- the more time physicians had, the more indirectly they approached the topic
- identifying victims of domestic violence required developing a trusting relationship with patients over time to increase the chance for future disclosure
- it was more effective to approach the topic of domestic violence indirectly so as to not be seen as judgmental when patients' cultural beliefs, ethnicity, sexual orientation and social class are different from that of the physician
Co-authors of the study are Nona Caspers, MFA, Amy Bronstone, PhD, James Moe, PhD and Priscilla Abercrombie, RN, NP, PhD, research associates, division of behavioral sciences, UCSF School of Dentistry.
The study was funded by the National Institute of Mental Health.
Journal
Annals of Internal Medicine