ER doctors can uncover domestic abuse: study
Reported November 07, 2007
TORONTO — Even in a busy hospital emergency department, physicians can help abused women to open up about domestic violence if they take the time to ask the right questions in the right way, a U.S.-Canadian research team has found.
But too often, rushed ER doctors trying to quickly diagnose and treat a patient will miss the opportunity for preventing future domestic abuse because they don’t frame their questions in the best way to encourage open communication, the researchers report in the latest issue of the Annals of Internal Medicine.
Their study analyzed audiotapes of 871 conversations between female patients and care providers at two socioeconomically diverse hospital ERs in the U.S. Midwest, one urban and the other suburban. Patients agreed to be taped and almost 300 of their conversations with doctors included discussions about domestic violence.
“One of the things that we found is that (asking about) domestic violence in the emergency room is like (asking about) smoking or drinking alcohol, and there was a certain rhythm and pattern in the way in which many of the physicians ask the questions,” said study co-author Richard Frankel, a professor of medicine at the Indiana University School of Medicine.
“Sometimes they would phrase the question in the negative: ‘You’re not a victim of domestic violence, are you?”‘ Frankel said Tuesday from Indianapolis. “It really shuts (patients) down and limits what they’re liable to say . . . Framing a question in the negative really makes it difficult for a patient to say: ‘As a matter of fact, I am.”‘
But the research team, which included Dr. Wendy Levinson of the University of Toronto, found that certain conversational techniques can have a profound effect on patients’ willingness to disclose details of domestic violence.
Frankel said those include: “Asking open-ended questions – ‘Can you tell me a little bit more about this?’ or ‘Tell me what’s been going on’; the use of continuers, when somebody starts to make a statement, you say ‘Mm, mm’ or ‘I see’ or ‘Go on,’ or you nod your head; the use of empathy: ‘That must have been very difficult for you.”‘
When patients feel listened to, they are not only more satisfied but they also have better health-care outcomes, he said, adding that it’s important that emergency room providers delve deep enough to find out if patients are experiencing abuse.
“For one thing, the emergency room is a source of primary care for more and more people, and one might speculate for people who are victims of domestic violence that might be more true,” said Frankel, a medical sociologist who specializes in doctor-patient communication.
“So where better than in the emergency room to screen for something like this? We know that it’s happening in epidemic proportions.”
It’s also critical that the physician or other care provider determine whether a patient is being subjected to repetitive trauma, so that steps can be taken to prevent it in future, he said.
That could mean getting a hospital social worker, adult protective services or the police involved, as well as sending the patient directly to a battered women’s shelter.
“For any or all of that to take place, the provider needs to recognize that domestic violence is occurring and is at the root of a patient’s presentation (of symptoms at the ER),” he said, noting that a domestic partner (who may also be the abuser) accompanying the patient is asked to leave before questions about possible violence are discussed.
Frankel said the study is part of a movement towards improving doctor-patient communications both among medical students and in clinical settings.
“Our job as medical professionals is to identify and care for people who are suffering and victims of domestic violence often suffer for years in silence,” he said. “And it takes a well-skilled professional to be able to reach out and be able to identify the problem and help.”
Source : The Canadian Press