For Doctors, a Chance to Spot Victims in Denial

For Doctors, a Chance to Spot Victims in Denial

Seeing Pattern of Abuse Is First Step to Help, Says Report

Victims of domestic violence show telltale signs of their abuse by a pattern of injuries that may be easily identified by doctors and social workers, experts say.

A report recently published in a British journal suggests that some domestic violence victims show bleeding in the eye, head injuries and the patterned bruising seen in shaken infant syndrome.

The report, in the Journal of Accident and Emergency Medicine, should alert emergency medical workers to the possibility of “shaken adult syndrome” and the need to act quickly, because victims often hesitate to admit they have been abused.

The report starts with the case of a 34-year-old British woman treated in the emergency room by Dr. Thomas D. Carrigan and his colleagues. Her injuries — two black eyes, a bruise on her scalp and parallel bruises on both upper arms — were inconsistent with her claim of having fallen down a flight of stairs after drinking a moderate amount of alcohol.

Physicians for a Violence-Free Society

The majority of abuse victims have milder injuries to the body, head and torso than those Carrigan described, said Dr. Patricia R. Salber, who is co-founder and co-president of Physicians for a Violence-Free Society, a nonprofit group of health care workers and others committed to reducing violence around the world.

Martha Hollowell, a Dallas County assistant district attorney who handles about 125 active domestic violence cases at a time, says she has seen at least one case that could be considered shaken adult syndrome.

The victim had a retinal hemorrhage, a black eye, a broken nose and bruising down the side of her face, Hollowell said. The victim told police that she had been shaken, choked and punched, but later changed her story, saying she slipped and fell near a swimming pool.

“That was a case we actually prosecuted without [the victim] because she did not want to prosecute,” Hollowell said.

Without the victim’s help, prosecutors depend on good documentation from investigators and medical staff. Documentation includes body diagrams noting all injuries, as well as photographs of the victim holding a card with her name on it to establish her identity in court if she refuses to appear.

Menace from batterers

Victims fear to tell their stories because of an ever-present threat from abusers, who often hover around their victims even in the emergency room, Hollowell said.

“Doctors need to note in the record if the victim acts differently when the perpetrator is out of the room,” she said.

Salber and Hollowell agree with Carrigan’s conclusion that more effective methods are needed to induce assault victims to confirm their abuse, especially in the hectic, chaotic atmosphere of a hospital emergency room.

Carrigan said in his report, published Feb. 24, that it took two days of repeated entreaties before the victim admitted that she was in an abusive relationship and reported her injuries to the police.

He noted that most domestic violence victims are discharged within hours of their arrival in the emergency room, which is too little time to persuade them to get help.

To solve the problem, Carrigan recommended that emergency departments create a system to follow up suspected cases of domestic violence, as is standard practice in handling child abuse.

Getting help

Three years ago, Salber’s group developed such a program, which has been used to teach an estimated 6,000 U.S. health care professionals nationwide to recognize and accurately document injuries associated with domestic violence.

The program stresses identification, validation, documentation, referral and assessment. Here’s how it works:

After a physician identifies suspected abuse, he or she validates the victim’s experience by listening empathetically. The doctor also gathers forensic documentation of abuse, such as detailed statements from the victim.
The doctor determines whether the victim has a safe place to go to and provides referrals to a hospital, social worker or victims’ advocacy groups and women’s shelters.
A domestic violence expert would then “close the loop” by contacting the referring physician to provide feedback on the woman’s situation.
Salber said primary care physicians who treat abuse victims over time have the greatest chance of overcoming victims’ reluctance in getting help.

It can take a woman months — even years — to leave an abusive relationship, so it is important for primary care physicians to repeatedly bring up the issue of domestic violence and to help the woman work through the issues she is facing, Salber said.

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