The Challenge of Managing Families With Intimate Partner Violence in Primary Care

Abstract

ince 1992, the American Medical Association has encouraged physicians to ask patients about intiSpartner violence (IPV). 1 Although this recommendation has existed for 15 years, studies show that there is room for improvement, with less than 10% of physicians routinely asking about IPV. 2 A variety of studies have identified time constraints, discomfort with the subject, fear of offending the patient, frustration with patient denial, lack of skills and resources to manage IPV, and personal issues as barriers for physicians. 3‐5 In this issue, Heru et al. 6 point out the complexity of relationships with IPV in adult suicidal inpatients. These relationships include mutual perpetration of violence, poor anger management skills, and limited communication. It is no wonder that physicians do not want to open Pandora’s box. Physicians have many issues to deal with in their practices. Most physicians do not have the psychosocial training to manage the complexities of IPV, and the “fix” does not occur overnight. Why ask questions about something that one cannot treat or that seems unfixable? Physicians become frustrated with the victim’s reluctance to follow up on referrals. 3‐5 Despite the violence, the dysfunctional dance of the relationship is familiar. There are many reasons why victims do not want to end the relationship and why couples frequently want to continue the relationship despite the victim’s frustration and physical and emotional injuries. There are no easy answers, but living with IPV affects the health of all members of the family: the victim, the perpetrator, and the children. Exposure to IPV and household dysfunction as a child is associated with unintended pregnancy, sexually transmitted diseases, alcohol abuse, smoking, suicide, depression, and risk factors for heart disease, chronic lung disease, and liver disease in adulthood. 7‐11 Victims of IPV have poorer health than do nonvictims. 12‐14 Conditions such as chronic pain, somati