Wife abuse: universal screening
Online posting: May 9, 1997
Published in print: August 15, 1997 CMAJ 1997;157:365
Re: Documenting wife abuse: a guide for physicians, by Dr.
Lorraine E. Ferris, Ms. Margot McMain-Klein and Laura Silver,
CMAJ 1997;156:1015-22 [full text / résumé]
See response from: L.E. Ferris
As an emergency physician involved in the care of battered
women, I found this article interesting and informative.
However, I would like to offer a couple of suggestions. I
believe that the authors' proposals for standardizing care for
and documentation of wife abuse would be more relevant to
practising clinicians if the following points were addressed.
The authors suggest that physicians question women with
suspicious injuries and emotional difficulties about abuse to
identify victims of wife abuse. However, this approach is
inadequate. Although there is little doubt that such an approach
would result in an higher identification rates than
self-reporting, it would miss many abused women. The American
Medical Association has strongly endorsed the inclusion of
screening questions about violence in routine history taking:
"Due to the prevalence and medical consequences of domestic
violence, physicians should routinely inquire about abuse as part
of the medical history."[1] Several organizations, including the
Canadian Association of Emergency Physicians, the College of
Family Physicians of Canada and the Canadian Association of
Social Workers have endorsed a widely distributed manual that
recommends universal screening for abuse of all patients seen in
the emergency department.[2]
Even in an article that focuses on legal aspects of medical
practice, the authors should pay attention to the practicality of
the advice they offer. The purpose of intervention with battered
women, as with other patients, is to provide high-quality and
compassionate care. The elements of care are identification,
assessment, documentation, risk assessment and referral; thus,
care includes a legal component. The care should be as
hassle-free as possible for the abused women. Developing very
complex protocols, similar to the sexual assault protocol, may be
counterproductive because it may discourage many physicians from
addressing this problem. The legal aspects, although important,
are but small part in the day-to-day care of abused women.
I suggest that the authors include practising physicians in
the team involved in developing standardized forms for
documenting wife abuse.
Anton Grunfeld, MD
Domestic Violence Program
Department of Emergency Medicine
Vancouver Hospital and Health Sciences Centre
Vancouver, BC
grunfeld@unixg.ubc.ca
References
- American Medical Association Council on Ethical and
Judicial Affairs. Physicians and domestic violence: ethical
considerations. JAMA 1992;267:3190-3.
- Hotch D, Grunfeld A, Mackay K, Cowan L. Domestic
violence intervention by emergency department staff.
Vancouver: Vancouver Hospital and Health Sciences Centre, 1995.
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