Family Medicine Means We Ask About Our Patient’s Relationships

Therese Zink, MD, MPH

Therese Zink, MD, MPH

Good family medicine includes understanding whether or not our patients have a supportive relationship.

Intimate Partner Violence Happens Regardless of Ethnicity, Sex, or Wealth

Domestic violence, also known as intimate partner violence (IPV), is a reality everywhere—it happens to the rich and poor, men and women, and to all ethnicities. One in three women have some experience with IPV during their lifetime, and one in 10 men experience it. One in four have experienced severe physical violence by an intimate partner.

IPV Screening Is a Must in Prenatal and Perinatal Care

Two recent trials among pregnant women show asking about IPV and sharing resources impacts the recurrence of IPV, the occurrence of preterm birth, and women’s quality of life.

IPV screening is one of six recommendations in prenatal and perinatal care settings. The US Preventive Services Task Force says there is level B evidence (high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial) to screen women of childbearing age for IPV and share resources even if there are no symptoms of abuse.

IPV Screening

Asking about IPV is what we do as family docs. Understanding the context of patients’ lives helps us provide better care for them. It is about relationship and offering options and hope. When screening for IPV, it’s important to ask the right questions at the right time.

Don’t:

  • Ask in front of the partner or older children—privacy and confidentiality are important.
  • Ask leading questions.
  • Ask general questions a patient can evade.
  • Ask if your patient is abused—few people identify with that image.
  • Ask when you’re not prepared to advise on IPV—know your resources.

Do:

  • Start IPV screening questions with an introduction
    • Because violence is so common in many people’s lives, I’ve begun to ask all my patients about it.
    • I am concerned that your symptoms may have been caused by someone hurting you.
    • I don’t know if this is (or has been) a problem for you, but many of the patients I see are dealing with abusive relationships. Some are too afraid or uncomfortable to bring it up themselves, so I’ve started asking about it routinely.
  • Ask specific questions
    • Does your partner hurt you or make you feel afraid?
    • Are you in a relationship with a person who physically hurts you or threatens you?
    • Do you feel controlled or isolated by your partner?
    • Do you feel safe in your relationship?
  • Have resources available for your patients who have experienced IPV.

Patients With IPV Need More Than a Resource Card

When patients share that they have experienced IPV, linking them with resources includes more than just handing them a card or phone number. A warm hand-off is the most valuable. An onsite social worker or behavioral health specialist to do in-depth counseling with the patient is the best.

If you don’t have an in-house resource, put the patient on the phone with your local or national hotline. The national hotline has translator services available.

The advocate on the phone will discuss IPV, the patient’s situation, and what their options are. While the patient talks on the phone, you can see another patient and then return to check on your patient and arrange a follow-up visit.

IPV Resources for Physicians

On September 23, The Department of Health and Human Services sponsored a webcast,  Healthier Pregnancy: Tools and Techniques to Best Provide ACA-Covered Preventive Services, as well as more in-depth interviews with six experts, which will be available online later. Yours truly talked about IPV. The site also  links to tools and resources and Continuing Medical Education credit is available.

Other resources:

The bottom-line: IPV affects the lives of our patients. Understanding the context of patients’ lives helps us provide better care for them. It is about relationship and offering options and hope. It is about continuing the caring relationship.

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