Wife abuse: universal screening
CMAJ 1997;157:369
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]
In response to: A. Grunfeld
We are aware that several organizations recommend routine screening by all physicians of all female patients, since identification of victims of wife abuse is crucial.
Unfortunately, there is no evidence to support this routine practice. We feel that evidence of the beneficial impact of routine screening on the patientphysician relationship is needed before we recommend that screening be routine rather than discretionary. That being said, we believe that routine questioning could show patients that their physician is open to discussing the problem and may help patients who wish to broach the topic. Hence, an evidence-based approach to clinical practice guidelines leads us to suggest that physicians weigh the benefits and possible adverse consequences of screening in individual cases.
On the basis of research about the impact of questioning patients in suspicious cases, we support the recommendation that physicians ask about the possibility of abuse when a woman's physical injuries are not consistent with the reason given for them; when a woman exhibits unexpected or unexplainable stress, anxiety, depression or substance abuse; or when a woman has chronic, unexplained somatic symptoms such as headaches, gastrointestinal distress or insomnia. In terms of guidelines for emergency physicians, women with suspicious injuries are often seen in emergency departments, and screening in suspicious cases could greatly increase the rate of identification. We were surprised, given the case mix of patients and the volume of patients seen, that the manual by Dr. Grunfeld and his colleagues recommends "universal screening for abuse of all patients seen in the emergency department," and we appreciate his bringing this recommendation to our attention.
Physicians were substantially involved in our research. The guidelines were reviewed by several physicians before their submission to CMAJ. A protocol based on the guidelines incorporated physician feedback. We have conducted a pilot test of this protocol since it was published. FP/GPs who reponded to a survey strongly supported the use of the protocol, overwhelmingly believed that the protocol was useful and indicated that they would use it in their practice. Further testing is planned with other medical specialties.
Lorraine E. Ferris, PhD, CPsych
Division of Community Health
Faculty of Medicine
University of Toronto
Toronto, Ont.
Clinical Epidemiology Unit
Sunnybrook Health Science Centre
Institute for Clinical Evaluative Sciences in Ontario
North York, Ont.
 |
Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre |
Letters