LETTER
Domestic Violence and Physician Intervention
Sallie Rixey, MD, MEd
1 September 1996 | Volume 125 Issue 5 | Page 427
TO THE EDITOR:
Although I appreciate Dr. Weinberg's experience described in his recent essay, I fear that his story may inadvertently create barriers to intervention. For the last 6 years I have taught medical students, residents, and practicing physicians about domestic violence. My sessions begin by having the participants select their top reasons "why doctors don't ask" from a survey of 20 commonly offered statements. The results are always the same: "Don't know what to do; don't know how to ask; don't want to open Pandora's box." Opening Pandora's box is not a matter of time or scheduling. What is frightening about the contents of Pandora's box is the sense that the physician must own the problem, fix it, and be responsible for changing behaviors. One might interpret Dr. Weinberg's intervention as just that.
Dr. Weinberg chose his approach because he was the learner. What he learned was the power of nonjudgmental support in helping the patient to heal. Each of us must take the time necessary to learn about interpersonal violence and relating to patients for whom this is an issue. We must then ask what is to be done about the other patients all of us, including Dr. Weinberg, see who have also been victims of interpersonal violence.
As a family physician, I screen all of my patients for violence in their family of origin and past and current relationships, just as I take a family history for diabetes. The numbers reported in McCauley and colleagues' article [2] come as no surprise to me. I do not, however, spend hours at the end of my work day counseling each patient. Rather, I manage their problems and their preventive care in the context of this and other aspects of their life circumstances. Just as I need to know whether a patient has diabetes to manage them appropriately, I need to know whether he or she lives in a violent home. I need to know when and how to refer. I need effective resources to be available to them.
Dr. Flitcraft [3] hit the nail on the head when she remarked that "the introduction of new clinical practices into a medical paradigm that is not only managed but determined by cost-effectiveness requires genuine advocacy by physicians." We also require the kind of science presented in Dr. Alpert's article [4].
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Author and Article Information
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Franklin Square Hospital Center, Baltimore, MD 21237
1. Weinberg R. Communion. Ann Intern Med. 1995; 123:804-5.
2. McCauley J, Kern DE, Kolodner K, Dill D, Schroeder AF, DeChant HK, et al. The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med. 1995; 123:737-46.
3. Flitcraft A. From public health to personal health: violence against women across the life span [Editorial]. Ann Intern Med. 1995; 123:800-2.
4. Alpert EJ. Violence in intimate relationships and the practicing internist: new "disease" or new agenda? Ann Intern Med. 1995; 123:774-81.
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