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Family Violence Prevention:
Framing the Question Dr. Beth C. Kaplan is an attending physician in Emergency Medicine at San Francisco General Hospital and an Associate Professor at UCSF. Kaplan has worked in collaboration with the Family Violence Prevention Fund and she has developed a model Emergency Department intervention for intimate partner violence which has been applied nationally and internationally. Kaplan spoke about ways in which health professionals should approach the clinical encounter when intimate partner abuse is suspected. She stated that health professionals need to have a high index of suspicion when a patient displays the signs of intimate partner violence. Kaplan explained that the provider usually conducts the screening for intimate partner violence while obtaining the history from the patient or during the review of systems. When needed, the provider should call for a trained interpreter to translate. A family member should never act as the interpreter. The provider should create a safe environment meaning that the provider should sit down and be eye to eye with the patient. The provider can establish a good rapport with the patient by paying attention to the type of language that he or she uses when speaking with patient. For example, the provider can choose to say statements such as, “I am concerned,” “It is not your fault,” “You do not deserve this” and “You are not alone; help is available.” The provider should speak to the patient alone and make sure that the patient is aware that the information from the clinical encounter will be kept confidential. If the provider cannot speak privately with the patient, then the provider should not ask the patient about abuse. The reason is that the provider should never arouse suspicion. Instead, the provider can try to speak to the patient at another time (i.e. when the patient is on the way to get a lab test) or the provider can discreetly give a phone number or a pamphlet to the patient. It is important that the provider make an effort to make some basic intervention, even if it means just giving the patient a phone number. Kaplan said that providers may find it difficult to frame the question and broach the subject of intimate partner violence. She recommended that screening be done for all women and also members of the gay and lesbian community. Situations may arise where the patient denies abuse and the provider remains suspicious. For these cases, Kaplan suggested that the provider record his or her concerns in the patient’s medical records. Even though the patient denies abuse, the provider can still ask the patient, “Do you know where you could go to get help if you were afraid of your partner?” Again, the provider can also give the patient referrals and information pamphlets. If the patient does disclose information about intimate partner violence, the provider should take photographs and document the information in the patient’s file using the patient’s words. Kaplan emphasized that the provider should be empathetic and show concern to the patient. Above all else, it is important for the provide to remember that any intervention, even if it is a brief intervention, can make a big difference to the health and well-being of the patient.
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