Takeaway
Preparing and coaching your healthcare team to have open, honest dialogues with patients about intimate partner violence is essential. Failure to screen and address this matter is dangerous, while doing so can save lives.
Lifelong Learning in Clinical Excellence | September 6, 2018 | 3 min read
By Michelle Patch, MSN, Johns Hopkins Medicine
We’re re-featuring this piece in recognition of Domestic Violence Awareness Month 2024.
Asking about intimate partner violence (IPV) is critically important to the health and safety of your patients. One in three women and one in four men have experienced physical violence by a partner at some point in their lives (CDC, 2010). IPV has been correlated with many physical, psychological, reproductive, and sexual health issues, and IPV screening by clinicians has been found to be both effective in detection and welcomed by patients. Routine screening for IPV is recommended by the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians, among others.
Yet, in busy healthcare environments, it can seem difficult and awkward to ask patients about abuse. Distractions and time pressures can compromise your message of caring, leading to rushing through the questions, asking while buried in your computer, or even saying, “You aren’t abused, are you?”
The way you approach this sensitive topic can have implications for your patients’ comfort level with other disclosures or in sharing things with you in the future. Our collective 50+ years of working with patients and families experiencing violence have taught us a few things. Here are some pearls we hope you’ll find helpful as you engage in your clinical career:
1. You often can’t tell if someone is being abused just by looking at them.
Actually asking them is necessary. Just because they’ve denied IPV before doesn’t mean you should stop asking. You wouldn’t forego getting a blood pressure just because it was good last time, right? Things change. Asking about IPV can uncover important details to inform your care approaches and may even save a life. If possible, ask these questions along with other screening questions while she/he is still dressed. Sit down, on or below patient’s level, and use appropriate, supportive eye contact, and body language. Ensure privacy for your conversation.
2. Your patient may be feeling very vulnerable.
Take this into consideration from the moment you enter the room.
3. Create “lead-in” messaging that’s natural for you.
For example, “Now I’m going to ask a few questions that I ask every patient, because this topic is very important for your health and wellness.” The more you use it, the easier it becomes!
4. There are several different screening tools you can use.
No one tool has been determined to be the “gold standard.” Up-To-Date has compiled several you can choose from, along with their reported sensitivity/specificity.
5. Be ready for “yes” answers.
How will you handle them? What resources does your clinic or practice environment offer? Know what these are ahead of time, so you aren’t struggling in the moment and can be fully present for your patient.
6. Be a role model for others on your team, and prepare them well to respond to “yes.”
Sometimes, patients may tell you “no,” only to think about it a bit and later confide in another staff member. Staff may also pick up on subtle clues that you might otherwise miss. You are (or will soon be!) a clinical leader and have considerable influence on your team’s culture. Setting them up for success in addressing this concern is vitally important. Look for opportunities to talk about the topic at staff meetings, daily huddles/rounds, break room boards, or even quick hallway conversations.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.