Opinion 2.02 - Physicians’ Obligations in Preventing, Identifying, and Treating Violence and Abuse
Interpersonal violence and abuse were once thought to primarily affect specific high-risk patient populations, but it is now understood that all patients may be at risk. The complexity of the issues arising in this area requires three distinct sets of guidelines for physicians. The following guidelines address assessment, prevention, and reporting of interpersonal violence and abuse.
(1) When seeking to identify and diagnose past or current experiences with violence and abuse, physicians should adhere to the following guidelines:
(a) Physicians should routinely inquire about physical, sexual, and psychological abuse as part of the medical history. Physicians should also consider abuse as a factor in the presentation of medical complaints because patients’ experiences with interpersonal violence or abuse may adversely affect their health status or ability to adhere to medical recommendations.
(b) Physicians should familiarize themselves with the detection of violence or abuse, the community and health care resources available to abused or vulnerable persons, and the legal requirements for reporting violence or abuse.
(c) Physicians should not be influenced in the diagnosis and management of abuse by such misconceptions as the beliefs that abuse is a rare occurrence, does not occur in "normal" families, is a private problem best resolved without outside interference, or is caused by the victims own actions.
(2) The following guidelines are intended to guide physicians’ efforts to address acts of violence and abuse:
(a) Physicians must treat the immediate symptoms and sequelae of violence and abuse, while also providing ongoing care for patients so as to address any long-term health consequences that may arise as the result of exposure.
(b) Physicians should be familiar with current information about cultural variations in response to abuse, public health measures that are effective in preventing violence and abuse, and how to work cooperatively with relevant community services. Physicians should help in developing educational resources for identifying and caring for victims. Comprehensive training in matters pertaining to violence and abuse should be required in medical school curricula and in post graduate training programs.
(c) Physicians should also provide leadership in raising awareness regarding the need to assess and identify signs of abuse. By establishing guidelines and institutional policies it may be possible to reduce the volume of abuse cases that go unidentified, and consequently, help to ensure that all patients receive the benefit of appropriate assessment regardless of their age, gender, ethnicity, or social circumstances. The establishment of appropriate mechanisms should also direct physicians to external community or private resources that might be available to aid patients.
(d) Physicians should support research in the prevention of violence and abuse and seek collaboration with relevant public health authorities and community organizations.
(3) Physicians should comply with the following guidelines when reporting evidence of violence or abuse:
(a) Physicians should familiarize themselves with any relevant reporting requirements within the jurisdiction in which they practice.
(b) When a jurisdiction mandates reporting suspicion of violence and abuse, physicians should comply. However, physicians should only disclose minimal information in order to safeguard patients’ privacy. Moreover, if available evidence suggests that mandatory reporting requirements are not in the best interests of patients, physicians should advocate for changes in such laws.
In jurisdictions where reporting suspected violence and abuse is not legally mandated, physicians should discuss the issue sensitively with the patient by first suggesting the possibility of abuse, followed by describing available safety mechanisms. Reporting when not required by law requires the informed consent of the patient. However, exceptions can be made if a physician reasonably believes that a patient’s refusal to authorize reporting is coerced and therefore does not constitute a valid informed treatment decision. (I, III)