Rose Fife, M.D. |
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Youcef Sennour, M.D.
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OCTOBER IS DOMESTIC VIOLENCE AWARENESS MONTH
ISMA seminar offered tips to help identify victims of abuse
Abuse of women, children and the elderly — and the appropriate physician response — was the focus of a seminar presented by ISMA’s Committee on Family Violence. The session featured three IU School of Medicine faculty and a representative from the Indiana Coalition Against Domestic Violence. They provided these tips for helping patients who may be victims of violence.
Child abuse
Abused children incorrectly diagnosed will return to the same dangers and likely continue to be abused, warned Antoinette Laskey, M.D., assistant professor of pediatrics at IU.
Dr. Laskey suggested physicians look for these red flags:
- Head trauma in children under 4 years old
- Sexual abuse, even if the exams are normal
- Bruises on babies less than 36 months
- Tap water burns, the most common form of abuse in the U.S.
- Occult fractures
“If a child is in your facility and you are concerned they were injured at the hands of a caregiver, do not release the patient without first talking to child protective services,” Dr. Laskey advised.
Get information about diagnosing child abuse>>
Domestic Violence
About 37 percent of women seeking treatment in emergency departments for traumatic injuries are hurt by their male partners, noted Rose Fife, M.D., associate dean for research at IU and Barbara F. Kampen Professor of Women’s Health.
“Studies have shown that women are much more likely to discuss domestic violence if their physicians ask,” said Dr. Fife. She offered the following suggestions:
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Routinely ask patients in private, “Have you been hurt by someone in your life? Are you afraid of anyone in your life? Have you ever been forced to have sex against your will?”
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Ask about bruising, fractures and other injuries
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Consider domestic violence when a patient presents with vague or somatic complaints
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Verbally provide information about shelters
Elder abuse
“Physicians under-report elder abuse, mostly because they do not recognize it,” noted Youcef Sennour, M.D., associate director of IU’s Geriatric Medicine Fellowship Program.
Elder mistreatment can be physical, psychological and financial. Abusers are more likely to be a family member dependent on the victim for money or housing.
Evidence a senior patient may be abused include:
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Flinching or reluctance to make eye contact
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Diagnosis of dementia with a history of disruptive behavior
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Unexplained resistance to or fear of physical touch, removing clothes, toileting, bathing
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Depression, anxiety, insomnia
Dr. Sennour suggested physicians thoroughly document a senior patient’s history and physical exam. Also, ask questions about safety and physical abuse.
“There can be friction between the family and the physician,” said Dr. Sennour. “Go the education route. Tell the family you will have someone come in to help them.” Find information about elder abuse>>
Documentation and physician safety
“Physicians are instrumental in planting the seed to help a victim leave,” said Caryn Burton, M.S., training director for the Indiana Coalition Against Domestic Violence. “You are not going to make her leave, but when she does leave, she will not tell you.”
Burton explained that physicians can help patients who may be victims of domestic violence with proper documentation, like:
- Map bodily injuries and provide a detailed account of location and nature of all injuries.
- Note who inflicted injuries and if a weapon was involved.
- Use the survivor’s words when documenting and avoid extraneous medical facts.
- Avoid opinion statements. Include only medical facts.
- Take photographs but document photography procedures.
Burton advised physicians to have safety protocols in place, such as panic buttons in exam rooms or rooms with two exits, for helping patients in abusive situations.
“Always make sure you have a way out,” Burton warned. “Do not let a patient stand between you and the door.”
Find information and resources about domestic violence in the heath care setting through the Family Violence Prevention Fund Web site>>
The ISMA also offers domestic violence resources for its members.
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