At the very bottom of the family and social history page of our EHR program, there is a small box that has the option to check off if a patient has a history of physical abuse. It is very easy to overlook, if you aren’t looking for it. It’s even easier to overlook if you don’t want to discuss such a delicate topic with a patient.
One in four women report being physically or sexually abused by a partner, according to the CDC. Abuse is prevalent even in the teenage population — 20% of girls report intimate partner violence (IPV).
Emerging issues such a cyber stalking and Internet harassment play into IPV, and more young women are reporting pressure to text or email nude or sexually explicit photos.
In 2012, the American College of Obstetricians and Gynecologists (ACOG) published recommendations for regular screening for IPV at “periodic intervals” such as annual exams, prenatal checkups and family planning visits.
The ACOG identified providers of obstetric and gynecologic care as having a unique and important role in screening for IPV and educating women. Reproductive health issues such as unintended pregnancy and increased rates of sexually transmitted diseases are closely linked to domestic violence.
As uncomfortable as it can be for providers to screen for IPV, studies have shown that this fairly simple intervention does make a difference and can improve reproductive healthcare outcomes.
Yet, many providers feel uncomfortable discussing such a difficult and sensitive topic with their patients. They are uncertain about how to even broach the topic of IPV, and more nervous about what to do if the patient actually reveals that she is the victim of abuse.
In truth, there are many resources available to train and assist providers on the best and most effective methods of discussing and screening for IPV. Websites such futureswithoutviolence.org and loveisrespect.org offer educational materials for providers and patients alike, as well as questions to use for quick and effective screening for IPV.
Providers do not need to be experts in IPV to screen for it, and should not feel pressured to individually help every patient who reports abuse. However, a list of local and national resources should be available to assist victims, and every effort should be made to ensure her immediate safety.
These local resources, emergency hotline numbers, literature on IPV, and safety cards should be displayed in private areas such as restrooms, as well as waiting rooms, since abusive partners often accompany patients into the exam room. A woman might not feel comfortable discussing IPV the first time she is asked, but may quietly slip a safety card into her purse.
Under the Affordable Healthcare Act, screening and treatment for IPV is now included in preventative care at no extra cost. Asking a patient about IPV may be the most difficult yet important topic you can discuss. With a small amount of training and practice, it can become second nature and should be discussed at every visit.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.