Disclosing Domestic Violence: Role of Privacy and Modesty
Screening for medical and psycho-social problems should be a primary function in physician history-taking beyond asking about the symptoms for which the patient has come for consultation and treatment. Screening is a pro-active way of discovering conditions in the patient’s life which may lead to disorder and symptoms in the future. Screening often involves asking patients about whether they smoke, drink alcohol or take illicit drugs. Hopefully, with the feedback from the physician, the patients will understand the reason for screening and will be forthcoming in their answers. However, screening may involve issues which are felt by some patients to be “too personal” to disclose to anyone. Screening about sexual history and practices, as an example, is being discussed on another thread.
An important screening topic which physicians should inquire is history of domestic violence. This also is complicated by the patient’s concern about the privacy issues and consequences of providing the physician with such information if their abusive spouse finds that the patient “talked.”
An interesting article about this subject is present in Postgraduate Medicine Online
titled “Screening for domestic violence
Identifying, assisting, and empowering adult victims of abuse” by
Katherine J. Little, MD in the August 2000 issue.
Barriers to disclosure are noted both on the part of the patient and that of the physician. Excerpts from the article:
Patients also face barriers to disclosing violent relationships. The perpetrator may have threatened to beat the victim more severely if she discloses information, or he might have implied that their children would be taken away. If the victim reported abuse in the past, she may have been blamed for the situation or the abuse may have escalated. Perpetrators may not allow victims who disclose information to participate in appropriate medical follow-up care. In some cases, a victim's cultural background may have taught her that she must accept her situation and that she should not question or discuss the subservient role into which she has been forced by the perpetrator.
Physicians face many barriers when trying to provide the kind of patient care that they themselves would expect to receive. Lack of time--to establish rapport with a patient, to hear in detail about all of her problems, and to ask a multitude of questions for further diagnostic elucidation--is a commonly cited reason for not routinely screening for domestic violence in primary care practice. Physicians do not want to open a Pandora's box of complicated social and psychological issues that could not possibly be evaluated in an allotted 30 minutes or less. Also, for some physicians, such a discussion may trigger memories of their own violent relationships; in such cases, the well-recognized survival technique of distancing oneself from a patient's pain may be ineffective.
I wonder if my visitors might discuss here how they would consider their being screened for domestic violence by their physician, perhaps as part of a routine history and physical. Would it be easier to disclose information about abuse if the questions were asked not face-to-face but in the form of a written or computer driven questionnaire? Is there a kind of modesty involved in this screening, modesty not to reveal ones private marital life? ..Maurice.