Project SAFE: Domestic violence education for practicing physicians

Abstract

F or more than a decade, domestic violence advocates and health care providers have recognized that education of physicians about domestic violence is a key to the development of a comprehensive health care response to battered women. Every surgeon general since Dr. C. Everett Koop has identified family violence as a major health problem and has called upon researchers and clinicians alike to become a part of the solution. With the growth of the National Center for Injury Prevention and Control at the Centers for Disease Control and an emerging emphasis upon research in family violence, there has been a virtual explosion in knowledge regarding the epidemiology and health consequences of domestic violence. Initial prevalence estimates suggest that at least one adult woman in five will be physically assaulted by her partner. In clinical settings, 22%-35% of injured women presenting to emergency services are abused by partners, 23% of women seen in a family practice clinic and 14% of those in a university internal medicine clinic are in violent relationships, and 17% of obstetrical patients are assaulted during their pregnancy.i” Such figures stand in sharp contrast to rates of domestic violence identified routinely by physicians in these settings. The consistent failure to identify domestic violence in clinical practice has led to an emphasis on protocols and education as tools to help physicians address domestic violence in clinical evaluations. Nevertheless, the task of educating practicing physicians has proved difficult. In one of the first evaluations of a domestic violence protocol, McLeer et al successfully increased the rate of identification of abuse in an emergency department from 5.6% to 30% of female trauma patients. However, upon follow-up evaluation at the same site, rates of identification had dropped back to 7.7%, not significantly different than the baseline rate of identification.4 Kurz and Stark provide a more descriptive evaluation in their study of encounters between battered women and medical staff in a Philadelphia emergency department. They found that in the absence of an onsite advocate, clinicians tended to dismiss abused women as “evasive” and “repeaters” who will “just return home anyway.“5 Q 1995 by The Jacobs Institute of