Hopelessness. You spend a lot of time with it in medical school. Either you’re preparing for an exam or you’re wondering how you’re ever going to recover from one. You surrender yourself to third year and there are new things to feel hopeless about—and they’re not just your own problems. Cancer, in its final stages. Insurance won’t pay for rehabilitation. There’s not enough family support but the patient doesn’t want to go to a nursing home. As a student just recently exposed to social issues it’s often frustrating to try and make someone feel better when you’re not entirely sure what you can do.
An incredibly common social issue that falls into the realm of physician responsibility is the issue of domestic abuse. Despite the fact that 81% of physician’s believe it is their responsibility to screen for domestic abuse, only 10% regularly do so. Even more disturbing, of the victims who present to hospitals, only about 5% are correctly identified. If medical students really are meant to spend more time with patients, then identifying victims and helping them through tough situations seems like a suitable job for the student.
The first step is to always screen. Whether you want to ask “Do you feel safe at home? Do you ever feel afraid in your relationship?” in sexual or social history, or even in ROS psych, the biggest barrier is simply asking the question. Even if your patient denies being a victim, by asking, you help them associate healthcare with a place where such things can be and should be talked about. It is also important to not form preconceived notions about what a victim looks like. If you screen everyone, you’ll never forget.
Once you have identified a victim, it is important that you validate their situation and their struggles by talking to them. Many victims feel that they are taking a tremendous risk by talking to anyone about their situation. It is important that you let them know everything said can be kept confidential. It is also important for you to let them know that domestic abuse is not okay—some victims will have been around domestic violence their entire lives and may not see their situation as any different than the ones they witnessed as children. But domestic abuse is never okay and this is a point you must stress to them while still understanding that abusive relationships are incredibly hard to leave. On average, a woman will attempt to leave seven times before she finally succeeds. There are many reasons why a woman may stay with an abusive partner, but it is important that you don’t blame them for staying—asking them if they’ve ever thought about leaving can be enough to start the ball rolling.
Finally, the patient can be given tools to begin helping herself find ways out. Safe homes. Legal options. Emergency checklists of the things they will need to take with them if they find an opportunity to leave. Every state has its own coalitions, resource centers, networks, councils, committees, and task forces for dealing with domestic violence and abuse. I would implore everyone to take a look at what resources are available for their patients in their areas when it comes to these matters, because physicians—and students—can be incredibly helpful for victims. To quote Anne Ganley:
“For some victims, the only professional with whom they have contact is the health care provider, and they will return again and again in hopes that their suffering will be alleviated.”
Although October is officially National Domestic Violence Awareness Month, I think it is also important to note that 1.3 million women are victimized by domestic violence each year in America, and one in four will be victims sometime in their lifetime. Domestic abuse is a constant problem, and for many women, it can be a source of tremendous pain. I would like to think that one day I will become much better at understanding how to navigate my patients through their social issues. But I also know that even now there are many things medical students can do to help some of their patients feel a little less hopeless.
Sources:
- Ganley, Anne. “Understanding Domestic Violence.” 1998. http://www.futureswithoutviolence.org/userfiles/file/HealthCare/improving_healthcare_manual_1.pdf
- Family Violence Prevention Fund. “Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers.” 1996.
- Rodriquez MA, Bauer HM, McLoughlin E, Grumbach K. “Screening and Intervention for Intimate Partner Abuse. Practices and Attitude of Primary Care Physicians.” JAMA. 1999; 282:468-74.
- Elliott L, Nerney M., Jones, T., and Friedmann, P.D. “Barriers to Screening for Domestic Violence. Journal of General Internal Medicine.” JGIM. 2002; 17:112-116.
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