If a woman relates a history that makes you highly suspicious of spousal abuse, are you obligated to report this to the authorities? What if the woman is adamant in her refusal to allow such disclosure? Would reporting be in breach of confidentiality and privacy issues? How does this vary from state to state?
—Felix N. Chien, DO, Newport Beach, Calif.

In every jurisdiction, reporting of suspected child abuse is mandatory. However, the reporting requirements for suspected spousal abuse vary widely. The rationale is that adults can decide what action to take on their own behalf, although the psychology of spousal abuse contradicts that idea. In California, where Dr. Chien practices, reporting of suspected domestic violence (also known as “intimate partner violence”) is mandatory, but there is significant noncompliance when the patient does not consent to the clinician’s reporting as required. A study of clinicians in this situation reveals that they are reluctant to report suspected abuse without the patient’s permission (West J Med. 1999;171:118-124). Each state has different rules for reporting such cases. For California, see www.respondtodv.org. Bear in mind that there are cases of false accusation, especially during divorce or child custody disputes.
—David S. Starr, MD, JD (118-7)