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Physician colleagues offer you tips on talking to your patients about domestic violence
e-Reports, October 25, 2010
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October is Domestic Violence Awareness Month

LaGrange family physician Rhonda Sharp, M.D., is surprised by the number of older women coming to her practice who are being abused.

Dr. Sharp, who chairs ISMA’s Committee on Family Violence, told the story of a 79-year-old female patient complaining non-stop about depression and dementia. Dr. Sharp treated the woman for both ailments but also began to connect the dots; the woman suffered from verbal abuse by her husband.

Earn CME while learning more about domestic violence

Learn to approach patients about domestic violence with ISMA’s online webinar “Effective screening for domestic violence” and earn one continuing medical education credit.

With just an hour of your time at your convenience, you will learn how to:

  • Approach a patient about intimate partner violence (IPV) in a variety of health care settings
  • Recognize certain behaviors and injuries that may indicate abuse
  • Apply intervention techniques if a patient screens positive for IPV
  • Apply methods of good medical documentation of abuse

Find the seminar on the ISMA website. For questions, call Jill Bruce at the ISMA at (317) 261-2060 or (800) 257-4762.

Defining and understanding
Domestic violence is not caused by any behavior of the victim, according to DaWana Stubbs, M.D., assistant professor of Clinical Medicine at the IU School of Medicine. She defines domestic violence as the establishment of control and fear in a relationship through violence and other forms of abuse. It can be physical, emotional, verbal, sexual or financial.

Symptoms of abuse include:

  • Somatic disorders
  • Depression
  • Anxiety
  • Chronic pain syndrome
  • Story and injury inconsistencies
  • Injuries to face, torso, breast, abdomen or genitals
  • Injuries in different stages of healing
  • Delay in seeking treatment

“Pelvic pain and anxiety are the common complaints in the women I see,” noted Dr. Sharp, who also sees women from a local shelter. “They often present with unexplained bruises and come up with some creative excuses. I ask directly if their husband or boyfriend is hitting them.”

Screening and documenting
ISMA’s Committee on Family Violence recommends you screen all patients for abuse. Explain that you regularly say to patients: “Because violence is so common, I routinely ask about it. Have you been hit, kicked or shoved by someone?”

“Documentation is very important,” commented Dr. Stubbs. “Be careful how you code a victim’s visit to your office because the abuser may see the explanation of benefits when it comes in the mail.”

Dr. Stubbs gave these additional tips on documentation:

  • Provide a written description of what happened using the patient’s own words. Avoid writing “the patient claims” or “the patient reports.”
  • Use a body chart to illustrate location of injuries.
  • Take photos of injuries and note the patient’s name, date and time of the photo, and your initials.

Helping your patient
On average, a person tries to leave an abuser seven times before finally making a permanent decision not to return. To help a patient, Dr. Stubbs suggests:

  • Letting the victim know it is not her fault
  • Listening to the patient
  • Being supportive and encouraging
  • Providing resources
  • Helping to develop a safety plan

Dr. Sharp advises providing patients with numbers to shelters and counselors. She also recommends you keep in contact with the patient by scheduling a return visit within a month.

The ISMA offers resources you can use for patients who may be victims of domestic violence on the ISMA website.

You’ll find:

  • A body chart to document injuries
  • A brochure with screening questions
  • The Power and Control Wheel
  • Resource cards with shelter numbers
Copyright: Information written and displayed on www.ismanet.org is the property of ISMA and may not be reproduced without expressed written permission of the Indiana State Medical Association.

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