Domestic violence is a complex problem that is prevalent throughout all dimensions of society regardless of socioeconomic background, religion, race or other factors. Several studies including those conducted by the American Medical Association and National Family Violence Survey suggest that health care workers often under report and fail to recognize domestic violence among patients, for reasons including failure to ask patients about injuries. Yet, health care workers have an ethical responsibility according to these agencies to not only report domestic violence but provide comprehensive and quality care to their patients.
Domestic Violence Misconceptions
According to the American Medical Association, many health care professionals have misconceptions about domestic violence, believing that it is rare, a private matter and that it may not occur in what they believe to be normal relationships. Still other health care professionals are under the impression that a woman may be responsible for her abuse. The AMA goes on to report that these misconceptions are often the result of lack of knowledge and training. Many health care workers lack the skills necessary to correctly document, assess and manage the care of patients who are victims. This may result in a failure to identify the most common presentations of domestic violence.
Frequency of Abuse
Domestic abuse is more common than many health care workers realize. According to the American Bar Association, between 1998 and 2002, 49% of the 3.5 million violent crimes committed against family members involved domestic violence. Half of all offenders in prison for spousal abuse were convicted for murdering their partners. The U.S. Department of Justice also reported that nearly 40% of victims sought treatment for injuries related to domestic violence or abuse at a medical facility or emergency room. This brings the health care worker squarely into the domestic violence realm. Many victims are raped, wounded with knives, have broken bones, loss of consciousness, or experience other internal injuries. Often as many as 28% will require hospital admission while another 40% will have received previous care for an injury.
Health care Responsibilities
The ethical responsibility of the health care worker is to intervene in an attempt to prevent serious further health consequences or death resulting from additional violence. A health care worker can intervene through various measures including political intervention if necessary. Healthcare workers can provide educational information to victims, and links to referral agencies that can provide support to domestic violence victims. Political intervention may include assistance to women that may have been denied access to proper health care insurance or help in the past. Health care workers may also become involved in communities where education of the public or other health professionals is necessary to increase awareness about community needs, the prevalence of domestic violence, or resources available to patients.
Health care workers can also provide support efforts to students and other young adults that may be in at-risk populations for domestic violence. Teenagers and young children are often exposed to elder and family abuse early on. Health care workers have a duty to respond to community needs by participating if possible in community educational forums or opportunities to educate young adults about the warning signs of domestic violence, including signs that may lead to violence in dating relationships. Health care workers may devote time to encouraging young adults to seek out trusting relationships or refer young adults to agencies that can provide them with the resources they need if they find they are in a compromising situation at home.
All health care workers have an ethical responsibility to screen patients for domestic violence and to intervene if signs, symptoms or problems are identified during examinations. Assessment and screening should be part of routine examinations and other health-related visits. By opening a door for patients, and assuring their confidentiality, health care workers may help a patient in the next step toward safety. Assessments may include determining the severity of violence, including whether a patient is at risk for violence related to homicide. Documentation should be part of formal assessment, which may include photographs. Intervention may also include long-term health planning. The person affected by domestic violence ultimately has to make the decision to leave or take other action. Health care professionals however, who become involved in the education, prevention and treatment of domestic violence can work towards making a significant contribution toward curbing the violence.
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