Did Your Doctor Ask About Domestic Violence?

The last time I had a mammogram, as the technician and I were finishing up, she asked me a question: “Do you feel safe at home?” I do, but I was surprised she asked. I’ve been getting mammograms for 15 years and nobody had ever screened me for domestic violence before.

She explained that the mammogram exam room is a safe place for her and her colleagues to ask women questions about domestic violence. Partners aren’t in the room or even in the adjacent waiting room—they wait out in the main lobby. Women have privacy, so they may feel comfortable opening up about their abuse.

For women who don’t feel safe, the technician can provide lists of local resources. And women can add a phone number to their contacts or take a photo of a brochure if they are worried about their partner discovering printed information.

Domestic Violence Screening Is Spotty

Healthcare professionals like my mammography technician can play a key role in helping domestic violence survivors connect with the care they need. That’s why the U.S. Preventive Services Task Force recommends that clinicians screen women of reproductive age and provide or refer women who screen positive to support services. (They found that the evidence is insufficient to recommend screening for older or vulnerable adults, even though domestic violence among seniors is a very real thing.)

The American College of Obstetricians and Gynecologists, World Health Organization, and Centers for Disease Control also have guidelines. 

But despite those guidelines, not all women are being screened. A study published in the Journal of the American Medical Association found that 79% of primary care physicians routinely screen injured patients, however routine screening was less common for new patient visits (10%), periodic checkups (9%) and prenatal care (11%).

The Agency for Healthcare Research and Quality identifies these barriers:

• Time constraints
• Discomfort with the topic
• Fear of offending the patient or partner
• Need for privacy
• Perceived lack of power to change the problem
• Misconceptions about the risk of exposure to violence

One study found that physicians and nurses reported that training, community resources, and professional tools, protocols and policies were helpful in their screenings for domestic violence. 

Primary care, emergency, and OB/GYN docs are often tasked with screening for domestic violence, but some specialists ask questions as well. 

Tsippora Shainhouse, MD, a Los Angeles-based dermatologist who served on the domestic violence committee at Kaiser Permanente and received a grant to study domestic violence training, often asks her patients if they are experiencing abuse.

Bruises always raise her concern, and she’ll ask all her patients, regardless of age or gender, how they got them. “For adults I will specifically ask if someone did it to them. If the answer sounds strange to me, like they ‘fell,’ then I push a little further to see if I feel comfortable with that response,” she says.

She keeps phone numbers for national domestic violence hotlines and websites, as well as emergency numbers and women’s shelters on hand in case she needs to provide them to her patients. 

Do Screenings Make a Difference?

It appears that screenings do make a difference. A study that assimilated the results of 59 other studies found that 11% of people answering the screening had experienced domestic violence in the last 12 months, 32% of those accepted referrals to other resources, and 54% of those attended or received the referral services

Other studies have found that interventions reduced episodes of violence and reproductive coercion. 

Not Just Women

Most of the research has focused on women. And that makes some sense, since women are more likely to experience domestic violence than men. But men aren’t immune, and may be more reluctant to admit they are being abused. Shainhouse believes it’s important to screen men, women, children, and older adults for signs of abuse.

Start the Conversation

If you’re a domestic violence survivor and you feel comfortable talking to a healthcare professional, you can open the conversation yourself. Ask your doctor, nurse, or technician for referrals and resources that can help you be safer.