'You're Not A Victim Of Domestic Violence, Are You?'

The study of doctor/patient discussions of domestic violence in emergency departments, the first such work in more than 25 years, appears in the Nov. 6 issue of the Annals of Internal Medicine.

The emergency department is typically a busy place where doctors are required to make quick decisions about triaging people based on the seriousness of their problems. But it is also a place where women who are victims of domestic violence come for medical help, even if the cause of their injuries is not immediately apparent. The researchers reviewed 871 doctor-patient interactions audiotaped in an urban and a suburban emergency department. About a third of these interactions included screening for domestic violence.

"As we looked at the transcripts we noticed that asking about domestic violence was often very routinized and similar to asking about health behaviors such as smoking or allergies. In addition, questions were often framed in the negative 'you aren't a victim of domestic abuse, are you?' which elicited a negative or incomplete response," said Richard Frankel, Ph.D., professor of medicine at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

According to Dr. Frankel, who is a medical sociologist specializing in doctor-patient communication, patients were more likely to disclose experiences with abuse when providers used open-ended questions to initiate the topic of domestic abuse and probed for abuse by asking at least one follow-up question.

"Taking the time to be empathic, voicing concern, checking to be sure that the patient is not in any current danger, and reinforcing the importance of following up with referrals are all part of effective provider-patient communication that can stop domestic violence," said Dr. Frankel.

In addition to his IU School of Medicine and Regenstrief appointments, Dr. Frankel is with the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center in Indianapolis. He is also affiliated with the Family Violence Institute, an Indiana University Purdue University Signature Center.

The Annals of Internal Medicine study was funded by the Agency for Healthcare Research and Quality. In addition to Dr. Frankel, authors of the article are Karin V. Rhodes, M.D., M.S.; Naomi Levinthal, M.A.; Elizabeth Prenoveau, B.A.; Jeannine Bailey, M.A.; and Wendy Levinson, M.D.