Domestic violence screening.(Women's Health Adviser)

Domestic violence exacts a tremendous toll on women. Every year nearly 5 million American women experience it. Up to 20% of emergency department visits by women are related to domestic violence.

Because of its prevalence, and because domestic violence crosses every demographic boundary, the American College of Obstetricians and Gynecologists recommends a brief domestic violence screening for every patient.

Signs and symptoms

It's unlikely that the ob.gyn. will encounter abuse injuries that demand immediate treatment. Bruises, scars, or other signs of trauma that don't fit with the patient's explanation should be red flags. Women may also present with a variety of somatic complaints, including depression, anxiety, panic disorders, trouble sleeping, and unexplained pain.

Screening

Despite their reluctance to broach the subject, about 90% of women believe their physician can help them with problems of domestic abuse.

Screening questions can arise naturally during a patient history. Try beginning the screen directly after asking the patient how her home life is going. Preface the questions with a simple statement such as, "I'd like to ask you a few questions about physical, sexual, and emotional trauma because we know that these things are common and affect women's health." This establishes you as a knowledgeable, nonjudgmental, and sensitive ally who is ready to help.