Addressing Domestic Violence: The (Long) Road Ahead

Domestic violence is pervasive in U.S. society, with adverse and often devastating lifelong effects on the health and well-being of individuals, families, and communities. It was virtually unrecognized as a health care issue until just 3 decades ago; since then, advances in education, practice, and research have added the words “domestic violence” to the medical lexicon. Such progress notwithstanding, the article by Rhodes and colleagues (1) in this issue reminds us of the (long) road ahead.

What has changed over 30 years? Aren't we doing better than before? Is the glass at least half full? Indeed, most medical schools and many residency programs now offer at least nominal domestic violence education to trainees. Curricular principles (2) and core competencies (3) have been developed and disseminated. Questions related to violence and abuse are found infrequently, but at least predictably, on licensing and certification examinations. We have made some progress.

The health care report card, however, still shows a grade of “needs improvement.” In fact, in 2001, the Institute of Medicine concluded that the state of health professional education and training in family violence could be summarized as a case of “chronic neglect” (4). The ability of most health professionals to effectively identify, assess, and respond to domestic violence has lagged far behind societal awareness and community responses. As Rhodes and colleagues (1) amply demonstrate, far too many …