TIME: Almanac 1993/TIME Almanac 1993.iso/time/062992/06299929.000

Text File | 1992-09-25 | 5.9 KB | 122 lines

                                                                                SOCIETY, Page 57

What the Doctor Should Do


Domestic violence is an epidemic, but physicians say it's not
their problem. The A.M.A. disagrees and wants to put them in
an uncomfortable new role.

By JILL SMOLOWE -- With reporting by Andrew Purvis and Andrea
Sachs/New York


    The woman arrived at the New Hampshire emergency room
badly bruised, with several cracked ribs. "Someone did this to
me. Someone did this to me," she muttered through her pain. The
doctor on duty just nodded, then asked if the bandage felt
comfortable. He made no attempt to elicit the ugly truth behind
her whispers: she'd been battered by her husband.

    Such scenes are appallingly common: one-third of all women
who arrive at doctors' offices or hospitals seeking emergency
treatment, and up to one-quarter of all those seeking prenatal
care, are victims of domestic violence. After years of averting
their eyes, of treating the symptoms while politely ignoring the
causes, doctors are being urged to play a new role. In an
unusually strong statement, backed by U.S. Surgeon General
Antonia Novello, the Ameri can Medical Association last week
declared that domestic violence against women is a true
epidemic, one that requires response from health officials.
According to new A.M.A. guidelines, physicians should routinely
screen female patients for incidents of abuse. "Domestic
violence is rampant, and doctors are part of the problem," says
Novello. "We have to retrain some of us to believe that domestic
violence with a fist is as important as violence with a gun."

    Horrors on the homefront are the leading source of injury
for women between the ages of 15 and 44. Each year 4 million
women are severely assaulted by their current or former partner.
Many of the victims fail to make it to the hospital in time:
more than half of female murder victims are slain by their
husband or boyfriend. "For too long, wife battering has been
thought of as a private matter," says Sally Goldfarb of the
National Organization for Women's Legal Defense and Education
Fund. "In fact, it's a public health problem of epidemic
proportions."

    While the A.M.A.'s statement supports that view, many
doctors are reluctant to wade into the domestic thicket. A
survey of physicians' attitudes about domestic violence in the
current Journal of the American Medical Association reveals
their concerns about the ever expanding roles they are expected
to assume in modern society and the enormous demands these make
on their time. In recent years they have been asked to take a
larger role in monitoring child abuse, explaining to very ill
patients that they have the right to refuse treatment and
screening for depression. "They feel they are being asked to
address the entire body and soul of the patient," says internist
Nancy Sugg, the study's co-author.

    Doctors are also concerned about the legal ramifications
of the A.M.A. directive. "If the physician fails to ask and the
patient is then further injured or killed, the patient or her
survivors could sue the doctor for failing to take action,"
warns Alan Meisel, director of the Center for Medical Ethics at
the University of Pittsburgh. "There is precedent for this in
the child-abuse area." On the other hand, while all 50 states
require doctors to report instances of child abuse, there is no
such requirement for reporting battered spouses. Says Meisel: "A
court might well say, `This is an adult. A doctor is not
responsible for protecting her.'"

    Doctors are often best situated to identify abuse
problems, however uncomfortable that might be. Still, abuse is
not always as obvious as a black eye or a broken rib, and
victims are often too frightened to reveal the true cause of
their injuries. "Abused women often present a very scattered
complaint picture that might include depression, sleep
disturbance, chronic anxiety, difficulties with mood," says
psychologist Angela Browne of the University of Massachusetts,
whose research shows that physicians rarely ask patients about
violence at home. "They might also have a history of injury. A
doctor must try to tie these disparate complaints together."

    Physicians should also be on the alert for explanations
that don't make sense: a patient may say she fell, but the
injuries are on her torso, not her extremities as in most falls;
she may say she slipped on an ice cube, not the same ice cube
that tripped her up a month earlier. Often women find a
partner's authoritarian control more scarring than the physical
injuries. Signs of emotional abuse include social isolation and
descriptions of intimidation, deprivation or humiliation.

    Because physicians are poorly trained to broach so
sensitive a subject, they should proceed gently, says Dr. Sugg.
Words like "domestic violence" and "abuse" should be avoided.
"Women will picture Farrah Fawcett in The Burning Bed and think,
`That's not me, it's not that bad.'" Instead, she recommends
that the doctor start very broadly ("How are things at home?")
and slowly narrow the field ("Have you ever been hit?," "Are you
being hit now?"). The A.M.A. is also distributing waiting-room
posters that read, WHEN SOMEONE YOU LOVE STRIKES OUT --
PHYSICALLY, VERBALLY, OR EMOTIONALLY -- TALK TO SOMEONE YOU
TRUST.

    Alas, doctors who identify victims of abuse cannot write
a prescription to cure them. They can only try to determine if
the patient can safely return home that day, and provide
referrals to social-service agencies and shelters -- and then
follow up. But that beats the old approach. "A classic response
is, `Here, take some Valium, go home, chill out,'" says Melissa
Eddy of the Texas Council on Family Violence. For battered
women, who often feel isolated and utterly worthless, the
concern of a high-powered professional and directions to people
who can help can make all the difference.