What to Ask Your Patients if You Suspect Domestic Violence
February 15, 2019
by Brook Jillings
Healthcare professionals are the most frequent point of contact for people seeking medical attention which puts them in the best position to identify signs of potential domestic violence in patients.
This makes it critical that they understand how to recognize domestic violence in patients and know what steps should be taken in this situation.
How you talk to potential abuse victims can mean the difference between your patient seeking potentially life-saving help or returning home to their abuser, so make the most of your opportunity to intervene when you suspect domestic violence.
Possible signs of domestic violence in patients
Domestic violence victims and their abusers often go to great lengths to conceal evidence of abuse, so signs may be subtle. "Domestic violence victims are afraid but can hide it very well," says Mary Joye, LMHC with Winter Haven Counseling and a writer for DailyOm.
"They often come to the office with their abuser, and they insist he/she comes in with them to their appointments. They can act like they are the happiest couple in the world."
To help see past this deception, there are several red flags from each party that commonly point to domestic violence in patients.
Patient red flags
When interacting with your patient, remember that signs of abuse are not always physical. "The most common identifying indicator of domestic violence is bruising and abrasions, but some signs of a person being in a domestic violence relationship can be hidden," says Nichole Horstkamp, a Victim's Advocate with the Center for Abused Persons.
"These signs can include not making eye contact with the abuser, but looking to the abuser for non-verbal cues, being easily startled by sudden noises like the door opening or closing and having psychosomatic complaints like headaches or stomachaches frequently."
Potential abuser red flags
Because victims are often accompanied by their abusers, it's important to also look for signs in anyone with the patient. "If the abuser is present, they can have several signs as well," suggests Horstkamp. "Mostly non-verbal, like clenched fists, or the victim may become silent after a look from the abuser.
The abuser may also try to interrupt the victim while speaking or talk over her." It's important to note that abuse may come from men or women, just as victims can be of any gender, so make sure to look at any present friends or family with a critical eye.
Creating a safe space
If you know how to recognize domestic violence in patients and you suspect someone you're treating is a victim of abuse, your first priority should be creating a safe place to speak with him/her.
Because abusers often accompany their victims during medical care, this means finding a way to separate your patient from their partner so you can speak privately.
Abuse victims are often on edge when their abuser is near and may not be honest about the situation for fear of provoking anger and additional abuse. "Pay attention to any signs of fear or anxiety," says Joye.
"Ask the other person to leave you alone with them in a very diplomatic way and then ask the suspected victim if they are afraid."
Questioning potential victims
Once you have a possible domestic violence victim alone, questioning that person must be handled delicately. Domestic violence victims are often made to feel isolated and as though they are at fault for their abuse.
It's important to let potential domestic violence victims know you consider their safety a priority and won't take any action that puts them at risk.
"Assure them you are there to help and not get them in trouble," suggests Joye. "Active listening and simple kindness can help a voiceless victim speak up and get out in time with a good exit strategy."
Talk to your patient
Once your patient feels comfortable enough to share their story, assess the situation to decide which approach is appropriate. In any scenario, take care with the language you use to avoid inadvertently placing responsibility for the abuse on the victim.
To gauge your patient's needs, start with broad questions that allow him/her to set the pace.
- --How is everything at home?
- --How is the relationship between you and your partner?
- --How are your other relationships?
If your patient seems responsive, it's okay to proceed with more specific questions cautiously.
- --Do you ever feel afraid of your partner?
- --Are you worried for your safety?
- --Are you concerned with your children's safety?
If your patient isn't responsive, you may be able to spark a response with questions that relate to your observations as a clinician or by framing them in a more passive way.
- --You appear to be showing signs of anxiety. Is there anything going on at home that may be causing this?
- --Your injuries suggest someone may be hurting you. Is there someone in your life who might be responsible?
- --Domestic violence can have a significant impact on health, so my policy is to ask all patients about it. Is domestic violence a concern for you?
Adjust your questioning based on each response you receive, and never assume your patient is comfortable with sharing.
Love for the abusive partner or fear for the safety of children or pets may cause a victim to fall back into denial, so try to allow your patient to set the pace and reassure them you are only there to help. Stay compassionate, and make sure to offer local or national domestic violence resources, even when the patient denies the abuse.
Even if your patient isn't receptive to your efforts, knowing how to recognize domestic violence in patients and deliver the appropriate response gives you the best chance at being an effective advocate.
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