UH Med Now
Chief Medical Officer’s Desk: Recognize and Refer domestic abuse
Pictured: MD students chanting and walking in the Men’s March Against Violence. Vina Cristobal photo.
In a significant demonstration of commitment and leadership, Dean Hedges and a number of the men (and women) of the University of Hawaiʻi medical school participated in the 24th Annual Men’s March Against Violence in Honolulu.
In our clinical practices, we are in a position to suspect or diagnose domestic abuse. While women can be the abusers of men, it is most often men who abuse their intimate female or male partners. Exhausted or malicious caregivers or family members may abuse elders. Some providers are reluctant to open this “Pandora’s Box” line of questioning for various reasons. They may think that a patient will be offended if asked. However, in studies, more than 80% of women appreciated being asked and thought more of the health care provider for asking.1
Providers should always spend time alone with a patient to given them the privacy to ask very personal or difficult questions. This is true even for elders with dementia whose responses may be surprisingly different when alone than with a family member or caregiver in the room. Some physicians are uncomfortable asking about abuse because they do not know how to deal with the problem. The approach is to recognize and refer to the experts rather than try to get into territory in which they are neither expert nor comfortable. The Stanford website listed below has an excellent brief video clip on interviewing a patient alone and asking the right questions. In Hawaiʻi, an excellent referral source is the Domestic Violence Action Center.2
If patients are not ready to make the call, they can be provided with ready access to this number and pre-printed advice to which they can turn when ready. UHP will be stocking our clinics with items that can be provided to patients so that they can have these readily and unobtrusively at hand.
For adults aged 60 and older with a disability, a provider who suspects abuse is required to report to Adult Protective Services (APS).3 If they are a member of a health care team, the provider is required to be assured that a designated team member is making the report.
The APS phone numbers are:
Dr. Blanchette writes a column “Wellness Watch” for the UHP newsletter. Read the newsletter.