The reviews on domestic violence and childhood abuse were excellent [1, 2]. Although presentations of both scenarios may include somatization, chronic pain, and various psychiatric disorders, the two papers suggest different screening strategies. Alpert [1] recommends that every patient be screened for ongoing violence during routine primary care, whereas Drossman and colleagues [2] suggest that screening be done "when the clinical data are suggestive."

The argument for screening for ongoing violence is stronger. Domestic violence presents a risk for repeated injury and death, which can then be prevented. Little evidence has yet suggested that eliciting a history of remote abuse will improve outcome. Still, I believe that we should broadly screen all patients about past and current abuse. Questions in a general inquiry can be linked to violence. As Alpert suggests, it is easier to ask these questions with practice.

There are other reasons to routinely ask about violence early in the physician-patient relationship. First, many patients will not show any of the target syndromes that have been associated with abuse. Second, it can be awkward to raise the question at a later date. Inquiry into the psychiatric underpinnings of somatic symptoms may be more acceptable at the start of a medical work-up rather than at a time when all organic possibilities for symptoms have been excluded. Third, some abused women are uncomfortable with pelvic examinations. Provider awareness of trauma before the examination allows modification of the procedure. Finally, inquiry based on selected symptoms or findings could foster false memories if we convey the sense that we strongly believe that a given presentation is likely to have been caused by remote abuse [3].