Interventions that Help Victims of Domestic Violence

Document, Refer, and Help the Patient Plan for Safety. These physicians stated that they were careful to write down the specifics of what the woman said. In addition to medical charting, some took photographs of any injuries with color Polaroid cameras. One physician stated that for the photographs to be useful in court “you have to include their face so that a lawyer can’t argue that you’re taking a photograph of someone else.”

The most practicable example of documentation was the development of a domestic violence packet which included a body chart, an instruction list for documentation, a compartment for the color Polaroid photograph, a handy tear-out sheet for information services (resources, shelters), and a telephone number for the police.

In general when physicians knew or suspected abuse they offered information about domestic violence and referrals to local community resources, hot lines, and shelters. Some stated that patients often refused referrals and that they kept referral sheets in the waiting room so that individuals could decide on their own whether to take one.

Other physicians stated that on occasion women had made statements such as: “I can’t take that (handout) home … it’s like a flag in front of a bull.” To address this problem some physicians reported putting business-size cards with domestic violence hot line numbers (eg, local hot line numbers, shelter numbers, or community resource numbers) in all the bathrooms, sometimes the only place where the batterer could not easily follow a woman. Participants reported:

[The cards] are constantly replenished [by housekeeping] … and one of the things I tell people if they’re in an explosive situation is to put it in their shoe, in the insole.

I have a very small practice. I do only office gynecology, but I put about 10 cards a week [in the bathroom]. I would bet 2 disappear in a week. Isn’t that amazing? And this is a fairly affluent area.

Physicians described various ways they had tried to help women plan for their own immediate and ongoing safety. Some physicians talked about trying to stay aware and sensitive to the safety needs of women whose partners are controlling them through abuse, even when the partners are not currently threatening violence. One participant said:

I’ll try to role-play with them … how are they going to deal with telling their partner that they have this infection or that they really want to use this type of birth control. I’ll say, “Some people in your situation could have a fight with their significant other,” and go through predicting some possibilities. Sometimes you can see them start to close down because they know that could happen, or this is a repeated thing that they keep getting that they have no control over. So, I’ll say, “Well, I have other patients in this situation who sometimes need a safe place to go,” or I’ll talk about what somebody else did and at the same time give them some information.

Physicians also reported counseling victims to keep a suitcase packed and have 24-hour hot line numbers or contact numbers for safe places, and helping them to specify what circumstances should cause them to call the police.

Although physicians stated that acute cases were rare outside of the emergency department, they described attempts to ensure safety when the woman’s life was in immediate danger. These attempts included (1) working as a team to separate the partner from the woman (eg, the nurse talked with the abusive partner in the waiting room while the physician cared for the victim and, with the victim’s permission, called the police and a domestic violence advocate to remove her from the abusive home); (2) making excuses to separate the abuser from the victim in the immediate situation (eg, taking the woman for tests); and (3) admitting women who could not be placed in a shelter into the hospital under a false name. One physician reported that the hospital at which she had trained had a safe bed designated for victims of rape, domestic violence, and other assaults.

Using a Team Approach. In general, the physicians agreed that it takes a team approach to intervene successfully with victims of domestic violence. Some expressed frustration about accessing community referrals and discussed the benefits to victims of readily accessible resources on site. The on-site resources referred women directly to the nurse, rape crisis counselor, social worker, behavioral medicine counselor, or psychologist, who counseled the women and conducted follow-up. Some physicians without access to onsite counselors or social workers described making domestic violence part of every staff member’s educational process when they come on board.