Domestic Violence Is Major Health Issue, Says Penn Physician

October 09, 1998

(Philadelphia, PA) -- A few years spent on a Navajo reservation opened the new doctor's eyes to the enormous amount of domestic abuse that occurs every day ... and is quietly tolerated ... in American society. Today, Jeffrey Jaeger, MD, a soft-spoken primary-care physician, works relentlessly to educate and recruit his professional colleagues to his point of view; namely, that domestic violence is a huge health epidemic that can be reduced with the help of aggressive physician involvement. Current estimates suggest that between 2 and 4 million American women are physically abused every year.

"Domestic violence is universal: it does not discriminate by age, race, or social position," explains Jaeger, assistant professor of medicine at the University of Pennsylvania Health System. Although many victims of domestic violence present to Emergency Departments with obvious signs of overt traumatic injury (such as bruises, burns, cuts, broken bones, etc.), the majority of patients who suffer such abuse complain to their primary-care physician about multiple bodily problems or stress-related illnesses.

For this reason, notes Jaeger, primary-care physicians are in a unique position to be an effective front-line of defense against potentially recurring acts of domestic violence -- simply by becoming involved. However, most physicians fear that anything other than a "don't ask, don't tell" stance will cripple their ability to see other patients because of the excessive time commitment they feel will be involved in dealing with victims of domestic abuse.

"Physicians are not social workers and cannot spend hours with one individual," admits Jaeger matter-of-factly. "But I ask my colleagues, 'If you can potentially save someone's life in 15 minutes, then why not do it?'"

"If you ask, you will find the problem," states Jaeger knowingly, for he has frequently uncovered instances of abuse among his patients by just asking if it exists. "During the history-taking portion of the exam, if you ask directly and in a non-judgmental manner, many patients will disclose," he says. "I ask my patients if they're currently involved in a relationship in which they are being hurt or feel threatened. If they say no, we move on. If they say yes, then I ask if they want to talk about it."

Although some patients (as well as physicians) feel that direct questioning about possible abuse is impertinent, Jaeger counters that it's necessary if one believes, as he does, that domestic violence is a serious threat to health. "We used to think that it was impertinent to ask about a person's sexual activity, but we now routinely inquire about our patients' sexual relations to help us detect or diagnose high-risk behaviors," he says.

According to Jaeger, the physician who asks about domestic abuse is communicating to the patient that s/he is someone who considers domestic violence a health problem. "Identifying the abuse doesn't fix the problem, but it helps the physician get a better picture of the whole problem so that the patient can be referred to appropriate resources," explains Jaeger. Once a problem is uncovered, the next step is to assess the patient's safety ... and then offer access to resources as may be available in the community.

To encourage his professional colleagues to proactively uncover and treat domestic violence, Jaeger recommends that they follow the practice guidelines developed and recommended by the Massachusetts Medical Society. Known by its acronym, the RADAR system reminds physicians of the following practice principles: Routine Screening; Ask Direct Questions; Documentation; Assessment of Safety; and Referrals. "When talking with my colleagues about tackling domestic abuse, I explain to them that it's similar to treating other medical problems such as diabetes -- which is a complicated problem with potentially diasastrous outcomes in which simple interventions can make a difference."
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Editor's Note: Dr. Jeffrey Jaeger can be reached directly at (215) 662-7037.
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University of Pennsylvania School of Medicine

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