Q: How could doctors miss that I was being abused? When I was admitted for a stroke, injuries to my spinal cord and a TBI [traumatic brain injury], they didn’t even ask about abuse. How can they go through medical school, see my injuries and not even once ask about domestic violence? It’s been four years and now I’m struggling to live. – Anonymous
First off, I’m so sorry you had to endure that and are still living through the aftermath today. You’re right—a doctor should have asked. Domestic violence experts support a coordinated community response to the problem of domestic violence, and the medical community should be a part of that response.
It could have been in that moment, in the ER or your doctor’s office, that you felt comfortable opening up and sharing what was going on at home. In the midst of all of your injuries, you may not have felt like you were in the right state to start volunteering that type of information, but if someone would have asked the right questions, it may have been easier for you to reveal what was going on.
Unfortunately, there is no set requirement for doctors to ask their patients about domestic violence, says American Academy of Family Physicians Board Chair, Wanda Filer, MD. And, since curriculum varies from one medical school to another, it’s hard to say if all doctors receive formal training in domestic violence before donning a lab coat. Some 15 years ago, the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) recommended all healthcare systems put protocols in place to ask about domestic violence, but these protocols vary widely. “It’s not required in the sense of checking blood pressure, but it is strongly advised,” says Filer.
Filer wishes very much that she had asked a patient about domestic violence some 25 years ago, but the topic was hardly ever broached in the medical community. Filer was the on-call doctor one weekend when a woman went into labor. She went into the hospital to check on the newborn baby and talk to the mother. Though she discussed breastfeeding and vaccinations, she never thought to ask if the young mother felt safe at home. Two weeks later, the woman’s abusive husband murdered his wife, along with their two older children, the woman’s mother, and her mother’s 2-year-old child. The only survivor was the newborn baby Filer had treated.
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“It was a life-altering, career-altering, event,” she says. “I had spent three years in family medicine and never heard anything of domestic violence.” So, for the last 25 years, Filer has dedicated herself to advocating for domestic violence awareness and education among medical professionals while operating a family medicine practice in Pennsylvania.
She both follows and advocates for an evaluation system called RADAR—routinely ask, ask direct questions, document answers, assess safety, then, referral. “I ask, ‘Have you been threatened with injury, threatened to be killed? Is there a weapon in the home?’ If violence is in an escalating pattern, every hair on my neck goes up. I say, ‘I’m very worried about you. I’m afraid you’re at risk for injury or death.’” She refers her patients who are in danger to nearby shelters and other nonprofits, even allowing them to call the crisis line from her office. “I tell her she can do that in the safety of my office because once she leaves, it’s unclear if she’s able to do that.” She’s certain RADAR has saved patients’ lives because many survivors, like you, Anon, are just waiting and hoping someone might ask.
In her talks around the country, Filer encourages medical professionals to dig a little deeper and look beyond the chief complaint of the patient. She also knows that asking depends on a medical staffer’s comfort level with knowing the answer. If they hear their patient is in trouble, says Filer, some feel like they’ve just opened Pandora’s box.
“They don’t know what to do with it,” she says, which is why she also advocates for a trauma-informed healthcare system that offers more than just a one-time training in domestic violence. She also hopes for changes in the future that allow doctors to have more time for each patient, another barrier to asking in-depth questions about home life. “Our healthcare system pays us in volume. I have 8 to 10 minutes with patients, but I need 30 to 45. My hope is that many of us [medical professionals] will get off that hamster wheel.
“Until we build a truly uniform trauma-informed system, these people are going to be missed and that’s going to be dangerous.”
To continue the healing process after your trauma, Anon, I encourage you to reach out to a domestic violence advocate in your area who you can share your story with and who can point you to additional healing resources in your area.
Ask Amanda is meant to offer helpful resources and information about domestic violence. If in crisis, please reach out to your nearest domestic violence shelter for the guidance of a trained advocate.
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