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Physicians have an important role in identifying victims of domestic violence and referring them for appropriate services

Only 8 percent of women abused by their partners ever tell a doctor, and less than 50 percent ever tell anyone. Although primary care doctors frequently provide brief advice for other health risks, such as alcohol use, many do not feel comfortable counseling women about abuse. Nevertheless, physicians should make an effort to identify and refer to community resources patients who have experienced intimate partner violence (IPV), according to Karin V. Rhodes, M.D., of the University of Chicago, and Wendy Levinson, M.D., of the University of Toronto. Their work was supported by the Agency for Healthcare Research and Quality (HS11096). They note that simply identifying abuse can influence the evaluation of patient complaints as well as the outcomes of care.

In a recent article, Drs. Rhodes and Levinson discuss three cases of IPV. In the first case, a 60-year-old white woman from an affluent upper middle-class suburb came to the emergency department (ED) complaining of chest pain. She had been hospitalized several times to rule out heart attack. In this case, the ED physician found the clinical diagnosis confusing and, after more detailed questioning, uncovered a long history of emotional and physical abuse by the spouse. The patient permitted the ED physician to discuss the abuse with her primary care doctor, who was surprised because the woman had been too ashamed to reveal the abuse.

The second case involved a middle-aged Hispanic woman who had been seen by her family physician multiple times in the past half year for asthma and anxiety or panic disorder. Upon questioning, she admitted emotional abuse but denied physical abuse, although that was later confirmed by a social worker. Because she had dependent children and no financial resources, the woman was not willing to leave her husband at that time. Nevertheless, women have reported that a discussion with a doctor who acknowledged the abuse and validated their self-worth was a turning point in the process of extrication from an abusive relationship.

The third case involved a 26-year-old black man who presented to an urgent care clinic for the third time with back and neck pain. A chart review revealed a history of depression and difficulty in controlling his temper. The patient was referred to a community mental health program, which included a treatment program for batterers.

See "Interventions for intimate partner violence against women: Clinical applications," by Drs. Rhodes and Levinson, in the February 5, 2003, Journal of the American Medical Association 289(5), pp. 601-605.

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