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It is routine in my practice to ask female patients if they are feeling any pain. Sometimes this question serves a purpose beyond what you might expect. In some cases, it can unveil cases of intimate partner abuse.
If you’re in an abusive situation, you might think you can’t talk to your doctor. Or perhaps you’re simply afraid or embarrassed to do so. But the truth is you can — and should — discuss abuse with your doctor, for your own health, safety and well-being.
Don’t be surprised if your doctor digs a little deeper if we sense that something’s wrong.
The U.S. Preventive Services Task Force recommends that doctors screen patients for intimate partner abuse. It’s not required, but it’s certainly something many of us do. But we have to go beyond a simple question on patient information forms.
We have to use our clinical radar to detect signs of abuse that don’t show up on an electronic health record.
Even if a woman answers “no” to questions about partner violence, clinical symptoms may suggest something isn’t right. If you keep coming back for appointments, or if you have signs of depression, insomnia or bruises, it’s my job to follow up with you.
For example, I once had a patient complaining of pelvic pain. Upon further examination and a series of tests, it turned out that her partner had physically abused her and ruptured her spleen. By asking the right questions, seeing her reaction, and getting her to open up about the problem, I was able to get her some much-needed help.
If you’re in this situation, it may take several visits before you’re ready to say, “Yes, I’m being abused.” But know this: Doctors aren’t trying to intrude — we’re trying to help.
When you’re ready for help, we can direct you to the right resources, including social workers.
Sometimes an abusive partner will accompany a patient to a doctor’s visit. It may look like they’re being a doting spouse or boyfriend. But this can be another form of abuse, a way of controlling their partner or watching over to make sure they don’t reveal the abuse to their provider.
If you’re in this situation, request that the doctor speak with you privately in another room. In some cases, practices will even have forms with a number to call for assistance in women’s bathrooms — a place where your partner is unlikely to follow you.
If you do reveal abuse, it will become part of your medical record. If you’re concerned that your spouse will see this information in an electronic medical record — or demand to see what tests have been done — let your doctor know. There are subtle ways doctors can document things to protect your privacy. For example, we can include language in the chart that will make sense to us but not be obvious to someone who isn’t a doctor.
There may come a point when your doctor needs to take things a step further and report abuse to authorities.
The American Medical Association guidance suggests that doctors routinely ask about abuse when taking a patient’s medical history, and that they should comply with local laws about reporting abuse.
In cases like this, I usually have a heart-to-heart talk with the patient. I explain all of the reasons why I want to take this step. I’ve done this on many occasions, and I’ve almost never had anyone say no to it.
You can get help either from domestic violence centers or social workers. These experts will help you make a plan of escape from an abusive partner. There are different degrees of “readiness” to escape, and everyone’s resources and situations will be different.
Intimate partner violence is more common than most people think, and it’s an equal-opportunity problem. It doesn’t just happen among poor and uneducated women. And even though I treat women in my practice, it can happen to men, too. It can happen within the LGBTQ community as well.
The important thing to remember is you don’t have to live in fear. People are willing to listen and support you — and your doctor is one of them.