PHYSICIANS WHO COMPASSIONATELY ASK ABOUT DOMESTIC VIOLENCE CAN ELICIT POSITIVE OUTCOMES, UCSF STUDY

By Lordelyn del Rosario on October 18, 1999

Physicians who compassionately ask patients if they are being physically abused
can provide the first step in helping battered victims get the help they need,
according to a UC San Francisco study.

The study looked at techniques physicians used to identify victims of domestic
violence.  It found that compassionate asking—not necessarily getting a yes or
no answer immediately—can help domestic violence victims find a way out of
their situations.

“A yes response from a patient should not be the goal of the physician because
there are so many reasons for a victim not to disclose the information,” said
Barbara Gerbert, PhD, UCSF professor and chair of the division of behavioral
sciences, department of dental public health and hygiene in the UCSF School of
Dentistry.  “And it’s frustrating for physicians if the goal is to get a yes
answer.  So what we found from these successful physicians is that they
realized that it’s their job to ask in a validating way that’s non- judgmental
and gentle, and in a way that let’s the woman tell her story if she wants to.”

This process, Gerbert said, can plant a seed in victims.

“In a previous study we had done with survivors of domestic violence, we found
that they remembered physicians asking in a gentle way and often held that with
them,” Gerbert said.  “They found it useful in helping them move toward
safety.”

The study, published in the October 19 issue of the Annals of Internal Medicine,
described some of the barriers physicians face in identifying victims of
domestic violence, such as a reluctance on the victim’s part to disclose this
kind of information because she feels afraid or ashamed. 
“That’s another reason asking in a non-judgemental way is helpful.” Gerbert
said “For physician to ask and say ‘no one deserves to be hit’ is an
empowering statement.”

Gerbert and co-researchers interviewed 45 physicians in the San Francisco Bay
Area who had expertise in identifying victims of domestic violence.  The study
found that physicians who screen for domestic violence incorporate the
questions into routine health histories, thus normalizing the issue and
reducing patients’ discomfort.  Some physicians also broached the subject
indirectly by asking patients questions such as how their home and work
situations were and if they were experiencing any stresses they want to talk
about.  Others probed over a series of visits or talked about domestic violence
in general terms, educating the patient on how large of a problem it is in
society.

## The study found that:

* the more time physicians had, the more indirectly they approached the topic;
* identifying victims of domestic violence required developing a trusting
relationship with patients over time to increase the chance for future
disclosure;
* it was more effective to approach the topic of domestic violence indirectly
so as to not be seen as judgmental when patients’ cultural beliefs, ethnicity,
sexual orientation and social class are different from that of the physician.

Co-authors of the study are Nona Caspers, MFA, Amy Bronstone, PhD, James Moe,
PhD and Priscilla Abercrombie, RN, NP, PhD, research associates, division of
behavioral sciences, UCSF School of Dentistry. 

The study was funded by the National Institute of Mental Health.