Advertisement

Journal of General Internal Medicine

, Volume 21, Issue 9, pp 949–954 | Cite as

Hidden from plain sight: Residents’ domestic violence screening attitudes and reported practices

  • Arshiya BaigEmail author
  • Elizabeth Shadigian
  • Michele Heisler
Original Articles

Abstract

BACKGROUND: Domestic violence (DV) is prevalent across all racial and socioeconomic classes in the United States. Little is known about whether physicians differentially screen based on a patient’s race or socioeconomic status (SES) or about resident physician screening attitudes and practices.

OBJECTIVE: To assess the importance of patient race and SES and resident and clinical characteristics in resident physician DV screening practices.

DESIGN, PARTICIPANTS: One-hundred and sixty-seven of 309 (response rate: 54%) residents from 6 specialties at a large academic medical center responded to a randomly assigned online survey that included 1 of 4 clinical vignettes and questions on attitudes and practices regarding DV screening.

MEASUREMENTS: We measured patient, resident, and clinical practice characteristics and used bivariate and multivariate methods to assess their association with the importance residents place on DV screening and if they would definitely screen for DV in the clinical vignette.

RESULTS: Residents screened the African-American and the Caucasian woman (51% vs 57%,P=.40) and the woman of low SES and high SES (49% vs 58%.P=.26) at similar rates. Thirty-seven percent of residents incorrectly reported rates of DV are higher among African Americans than Caucasians, and 66% incorrectly reported rates are higher among women of lower than of higher SES. In multivariate analyses, residents who knew where to refer DV victims (adjusted odds ratio [AOR]=3.54, 95% confidence interval [CI]: 1.43 to 8.73) and whose mentors advised them to screen (AOR=3.46, 95% CI: 1.42 to 8.42) were more likely to screen for DV.

CONCLUSION: Although residents have incorrect knowledge about the epidemiology of DV. they showed no racial or SES preferences in screening for DV. Improvement of mentoring and educating residents about referral resources may be promising strategies to increase resident DV screening.

Key words

domestic violence domestic violence screening resident education 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Saltzman LE, Fanslow JL, McMahon PM, Shelly GA. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 1999.Google Scholar
  2. 2.
    Heise L, Garcia-Moreno C. Violence by intimate partners. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health. Geneva: World Health Organization; 2002:87–121.Google Scholar
  3. 3.
    Dahlberg LL, Krug EG. Violence—a global health problem. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health. Geneva: World Health Organization; 2002:1–21.Google Scholar
  4. 4.
    Collins KS, Schoen C, Joseph S, et al. Health Concerns Across a Woman’s Lifespan: The Commonwealth Fund 1998 Survey of Women’s Health. New York: Commonwealth Fund; 1998.Google Scholar
  5. 5.
    National Center for Injury Prevention and Control, Center for Disease Control and Prevention. Costs of Intimate Partner Violence Against Women in the United States. Atlanta, GA: National Center for Injury Prevention and Control, Center for Disease Control and Prevention; 2003.Google Scholar
  6. 6.
    Tjaden P, Thoennes N. Extent, Nature, and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey. Washington, DC: Department of Justice; 2000.Google Scholar
  7. 7.
    Grana SJ. Sociostructural considerations of domestic femicide. Fam Violence. 2001;16:421–35.CrossRefGoogle Scholar
  8. 8.
    Centers for Disease Control. Prevalence of intimate partner violence and injuries—Washington, 1998, MMWR, 2000;49:589–92.Google Scholar
  9. 9.
    Tjaden P, Thoennes N. Full Report of the Prevalence, Incidence, and Consequences of Violence against Women: Research Report. Washington, DC: Department of Justice; 2000.Google Scholar
  10. 10.
    Saltzman LE, Green YT, Marks JS, Thacker SB. Violence against women as a public health issue: comments from the CDC. Am J Prev Med. 2000;19:325–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Kernic MA, Wolf ME, Holt VL. Rates and relative risk of hospital admission among women in violent intimate partner relationships. Am J Public Health. 2000;90:1416–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359:1331–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA. 2001;286:572–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Eisenstat SA, Bancroft L. Domestic violence. N Engl J Med. 1999;341:886–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Campbell JC, Lewandowski LA. Mental and physical health effects of intimate partner violence on women and children. Psychiatr Clin North Am. 1997;20:353–74.PubMedCrossRefGoogle Scholar
  16. 16.
    Fogarty CT, Burge S, McCord EC. Communicating with patients about intimate partner violence: screening and interviewing approaches. Fam Med. 2002;34:369–75.PubMedGoogle Scholar
  17. 17.
    Rodriguez MA, Sheldon WR, Bauer HM, Perez-Stable EJ. The factors associated with disclosure of intimate partner abuse to clinicians. J Fam Pract. 2001;50:338–44.PubMedGoogle Scholar
  18. 18.
    Caralis PV, Musialowski R. Women’s experiences with domestic violence and their attitudes and expectations regarding medical care of abuse victims. South Med J. 1997;90:1075–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Titus K. When physicians ask, women tell about domestic abuse and violence. JAMA. 1996;275:1863–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Elliott L, Nerney M, Jones T, Friedmann PD. Barriers to screening for domestic violence. J Gen Intern Med. 2002;17:112–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Rodriguez MA, Bauer HM, McLoughlin E, Grumbach K. Screening and intervention for intimate partner abuse: practices and attitudes of primary care physicians. JAMA, 1999;282:468–74.PubMedCrossRefGoogle Scholar
  22. 22.
    Waalen J, Goodwin MM, Spitz AM, Petersen R, Saltzman LE. Screening for intimate partner violence by health care providers. Barriers and interventions. Am J Prev Med. 2000;19:230–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.PubMedCrossRefGoogle Scholar
  24. 24.
    Smedley BD, Stith AY, Nelson AR, eds. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Washington, DC: National Academy Press; 2003.Google Scholar
  25. 25.
    Recommendations for Clinical Preventive Services. U.S. Preventive Services Task Force. Available at: www.ahrq.gov/clinic/uspstfix. htm#Recommendatins. Accessed July 28, 2004.Google Scholar
  26. 26.
    Nelson HD, Nygren P, McInerney Y, Klein J. U.S. preventive services task force. Screening women and elderly adults for family and intimate partner violence: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2004;140:387–96.PubMedGoogle Scholar
  27. 27.
    van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–28.PubMedCrossRefGoogle Scholar
  28. 28.
    van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(suppl 1):1140–51.Google Scholar
  29. 29.
    Rose GL, Rukstalis MR, Schuckit MA. Informal mentoring between faculty and medical students. Acad Med. 2005;80:344–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Alexander GC, Casalino LP, Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA. 2003;290:953–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Brienza RS, Whitman L, Ladouceur L, Green ML. Evaluation of a women’s safe shelter experience to teach internal medicine residents about intimate partner violence. A randomized controlled trial. J Gen Intern Med. 2005;20:536–40.PubMedCrossRefGoogle Scholar
  32. 32.
    McCauley J, Jenckes MW, McNutt LA. ASSERT: the effectiveness of a continuing medical education video on knowledge and attitudes about interpersonal violence. Acad Med. 2003;78:518–24.PubMedCrossRefGoogle Scholar
  33. 33.
    Nicolaidis C, Curry M, Gerrity M. Measuring the impact of the voices of survivors program on health care workers’ attitudes toward survivors of intimate partner violence. J Gen Intern Med. 2005;20:731–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Sugg NK, Inui T. Primary care physicians’ response to domestic violence. Opening pandora’s box. JAMA. 1992;267:3157–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Borowsky IW, Ireland M. Parental screening for intimate partner violence by pediatricians and family physicians. Pediatrics. 2002;110:509–16.PubMedCrossRefGoogle Scholar
  36. 36.
    Hayden SR, Barton ED, Hayden M. Domestic violence in the emergency department: how do women prefer to disclose and discuss the issues? J Emerg Med. 1997;15:447–51.PubMedCrossRefGoogle Scholar
  37. 37.
    Tatara T, Kuzmeskus-Blumerman L, Duckhorn E, et al. The National Elder Abuse Incidence Study (NEAIS); Final report. National Center on Elder Abuse at the American Public Human Services Association in Collaboration with Westat Inc. for the Administration for Children and Families and the Administration on Aging in the U.S. Department of Health and Human Services; 1998.Google Scholar
  38. 38.
    Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences. A survey of patient preferences and physcian practices. Arch Intern Med. 1992;152:1186–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–36.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Arshiya Baig
    • 1
    Email author
  • Elizabeth Shadigian
    • 2
  • Michele Heisler
    • 3
    • 4
  1. 1.Robert Wood Johnson Clinical Scholars Program, Division of General Internal Medicine and Health Services Research, Department of MedicineUniversity of CaliforniaLos AngelesUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of Michigan School of MedicineAnn ArborUSA
  3. 3.Veterans Affairs Center for Practice Management & Outcomes ResearchVA Ann Arbor Healthcare SystemAnn ArborUSA
  4. 4.Department of Internal Medicine, Michigan Diabetes Research and Training CenterUniversity of Michigan School of MedicineAnn ArborUSA

Personalised recommendations