Why health care professionals are reluctant to intervene in cases of ongoing domestic abuse.

Abstract

Domestic vioknce often presents in health care settings, yet health care professionals sometimes miss obvious signs or fail to ask about abuse. Lack of training, the belief that domestic abuse is none of their business, and lack of system support are all reasons why domestic violence is often not identified. Clinicians may also have personal reasons for their lack of intervention, including lack of comfort with the topic or negative beliefs about women who are domestically abused. This chapter describes these barriers and offers practical steps clinicians can take to overcome them.Mrs. WT, a 32-year-old woman, presents to Dr. JK's office five months after her preterm delivery for a postpartum checkup with complaints of not feeling well and wanting a prescription to increase her energy. She is also requesting sleeping medicine and a referral for tubal ligation. Mrs. WT describes to Dr. JK that lately she has been feeling very tired and not able to get enough sleep with three kids and her husband's odd work schedule. She says she has to pay lots of attention to her sick premature son, Joey.

A Qualitative Study of Intimate Partner Violence Universal Screening by Family Therapy Interns: Implications for Practice, Research, Training, and Supervision

“…The dilemmas encountered by participants in this study, and the difficult questions they create, seem to mirror the experiences of other health care providers. Hamberger and Patel (2004), for instance, identified the following barriers to screening described by physicians and nurses: lack of knowledge; fear of offending patients; perceived time pressures; perceived irrelevance of IPV to health care practice; fear of harming the patient–provider relationship; provider discomfort; uncertainty about how to handle a disclosure; patient lack of trust in the provider; and system‐level barriers. Perhaps consequently, “Countless women (and men) who seek health care, both acute and routine, are never screened for domestic violence, even when they present with classic domestic violence injury patterns” (Koverola & Panchanadeswaran, 2004, p. 50).…”

Palestinian Physicians’ Misconceptions About and Approval of Wife Abuse

“…Hamberger and Patel (2004) highlighted personal factors that can prevent physicians from being involved in identifying, detecting, and providing assistance to battered women (e.g., discomfort with the topic, negative beliefs about battered women), in addition to factors such as those mentioned above, including lack of training, the belief that the problem is none of their business, and lack of system support.…”

How Much Health Promotion and Disease Prevention Is Enough? Should Chiropractic Colleges Focus on Efficacy Training in Screening for Family Violence?

“…13,21,[45][46][47][48][49] Although a majority of medical and nursing schools report providing some information about family violence, many fewer students report having been trained to screen and manage family violence, 50 perhaps because curriculum offerings vary widely from content provided within required courses, to elective courses, to more systematic curriculum coverage. 13,[51][52][53] Although increasing family violence coverage has been noted in recent years, providers' perceived competence and screening behaviors do not seem to have been enhanced by didactics alone, at least not in the "dose" or modality to which many providers traditionally have been exposed.…”

“…13,27,45,55 Indeed, over the past decade most health professionals have witnessed a continual expansion of professional practice guidelines, as standards of practice have struggled to keep pace with emerging scientific advances in an ever-constricting health care resource climate. In an excellent illustration of these burgeoning professional demands in the area of family violence alone, Gerbert and colleagues 36 note that, although professional guidelines do not require physicians to assume the "full burden of intervention" for family violence, medical doctors are called to "play a large role" requiring levels of expertise, time, and focus well beyond the reasonable limits of most medical providers, such as to .…”

“…Some of the most commonly noted obstacles include the lack of empirically supported screening instruments and validated methods for identifying and treating patients, unclear system policies for reporting and managing family violence, uncertainties about the legal/professional requirements, questions regarding the efficacy of mandatory reporting and protective services agencies to address family violence problems, the paucity of on-site multidisciplinary collaborative relationships and accessible referral resources for consultation and patient follow-up, and the absence of private areas conducive to discussing sensitive family violence issues. 14,22,30,32,36,45,57,[60][61][62][63][64] …”