The doctor-patient relationship and the role of medical professionals as a trusted place for victims to seek help is the subject of a recently published article by the American Association of Family Physicians (AAFP).
Dr. Venis Wilder, a family physician, recently wrote about the need for health care professionals to have a plan for action when helping patients who may be suffering from abuse.
“Recently, ‘Doc, I trust you,’ has been followed by stories of abuse,” wrote Wilder. “My patients' stories often begin with a reference to trust for a variety of reasons: to ask for a listening ear to unload a hurtful past, to request assistance in locating and accessing resources, or to get medical evaluation and treatment in the aftermath.”
Commonly, abuse is inflicted by someone well-known to the patient, and as such, it puts family physicians in a strange position as they may treat both the victim and the perpetrator, explains Wilder.
Regardless, the statistics of abuse in this country are shocking. Twenty percent of women and one out of every 71 men have been victims of rape in their lifetime, and roughly half of those rape victims knew their attacker. Homicide is the second-leading cause of death for pregnant women and more than 700,000 children are abused each year.
There are, of course, mandatory reporting requirements for physicians. In most states, doctors are required to report any suspected mistreatment of a child, along with elder abuse, neglect or exploitation. When it comes to intimate partner violence, the laws vary significantly by state.
Both the AAFP and the U.S. Preventative Services Task Force recommend screening for intimate partner violence, and subsequently referring those who need it to intervention services. Wilder points out, however, that abuse can be difficult to detect.
“It has been my experience that it is the continuity and level of trust that a patient has with his or her physician that determines whether the truth will be revealed,” Wilder wrote. “It has taken years for some patients to confide in me, while others open up during a second or third visit.”
