Doctors can help stop abuse

The AMA provides a roadmap to address intimate partner violence.

Editorial. Jan. 27, 2003.

We're about to turn the calendar past the first month of 2003. That means the nation is nearly one-third of the way down the path set by Healthy People 2010, a collection of crucial national health objectives.

Violence is high on that list, because of the damaging impact it has on our collective mental and physical health. Enormous progress in combating violence is needed if our public health potential is to be achieved.

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That's why the AMA has chosen to focus physicians' attention on one of the most preventable forms of violence -- abuse among spouses and others in close relationships -- with the release of Case Studies in Disease Prevention and Health Promotion: Intimate Partner Violence. It wasdeveloped as part of the AMA program, Roadmaps for Clinical Practice. The goal of the entire series is to empower doctors with the clinical information they need to direct their patients toward the nation's overarching health goals.

Intimate partner violence offers an excellent starting point.

The AMA has long worked to raise awareness about such abuse through various initiatives, including the National Coalition of Physicians Against Family Violence and the hard work of the AMA Alliance.

The reason why is clear: Intimate partner violence is a pattern of behaviors that may include repeated battering and injury, psychological abuse, sexual assault, progressive social isolation, deprivation, and/or intimidation. Regardless of the form, the intent is always for one partner to exert control over the other.

Although physicians are sometimes reluctant to confront the issue, it has clear and compelling medical implications. For instance, unsafe home environments are increasingly being viewed as a significant risk factor for poor health and early mortality beyond acute injury. Additionally, a study published last year in the Archives of Internal Medicine found that abused women experience a 50% to 70% increase in gynecological, neurological and stress-related problems either as aftereffects of the abuse or as the result of the high level of stress that the abuse caused.

That leads to an important reminder. Multiple studies have shown that victims of abuse are more likely to seek help from a physician than from law enforcement. Therefore, intimate partner abuse is an area in which doctors can make a huge difference. On the flip side, however, a lack of awareness, understanding, and care cannot only jeopardize an individual patient, but undermine public health prevention approaches.

This monograph is designed to help physicians see beyond the obvious. Statistics indicate that those who are most likely to receive this abuse are young women; women who abuse alcohol or other drugs or whose partners do; pregnant women; or women who are planning a divorce or separation. But this is not an all-encompassing list. Intimate family violence is actually far more common and complex than most people -- including doctors -- care to admit, touching all ages, genders and walks of life.

The document will familiarize doctors with the magnitude of the problem by describing how to identify abuse and violence through routine screening and recognition of the signs, symptoms and clinical presentations.

It lays out specific model questions physicians can ask patients to discover those in need. It also offers examples on how to detail the abuse in the patient's medical history -- a step particularly important if legal action is taken. Finally, the monograph provides physicians with the direction they need to offer information to patients on appropriate, culturally sensitive referrals.

In addition to this monograph, the AMA hopes this year to continue the series with documents focusing on obesity, tobacco, immunization and minority communities -- all of which correspond with the goals of Healthy People 2010.

For now, though, physicians should take advantage of this first roadmap to increase their own awareness of this most preventable form of violence.

ADDITIONAL INFORMATION:

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To order Case Studies in Disease Prevention and Health Promotion: Intimate Partner Violence, $7 for AMA members, $8.75 for nonmembers, part of the Roadmaps for Clinical Practice initiative (http://www.ama-assn.org/ama/pub/category/9212.html)