Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Let's Talk About Intimate Partner Violence
Posted in Physical & Emot... by Dr. Sharon Orrange on Jan 31, 2012
As things currently stand, primary care doctors don’t routinely ask women about intimate partner violence during their primary care visits. Well, the American College of OB/GYNs has just gone against other organizations by recommending primary care doctors screen patients for intimate partner violence during regular and prenatal visits.

In many ways, I like this. I know for a fact though that some of my patients would be offended if I even asked them about this. We do need to be reminded how common intimate partner violence is, and the long term health consequences for women.

More than 1 in 3 women (36%) in the United States have experienced rape, physical violence, or stalking by an intimate partner at some point during their lives, according to recent data. Read that again. It is shocking and painful to see those numbers.

The consequences of intimate partner violence include chronic headaches, sleep and appetite disturbances, and recurrent vaginal infections among many other things.

Women of all ages experience intimate partner violence, but it is most prevalent among reproductive-age women. Because of this, should we take advantage during routine visits for pap smears and contraception to identify and help women who are being abused? This would mean asking questions about intimate partner violence to ALL of our female patients during their visits.

Why the debate? A 2009 report in JAMA found that screening for intimate partner violence produced a small benefit to abused women in quality of life and depression. Many trials have concluded that many women had to be screened in order to identify a single woman who disclosed abuse. So the problem here is that current evidence does not demonstrate that universal screening improves women’s health or well-being, or decreases their exposure to violence.

The other side would say that until evidence emerges in support of routine screening, primary care doctors become knowledgeable about the signs and symptoms of abuse, and screen for intimate partner violence only in those cases.

Thoughts?

- Dr O.


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32
I am a counsellor at a woman's shelter for victims of conjugal violence and this is what i have come to learn..it is not so much about confronting a woman so that immediate change can occur...it is about opening the door for her to feel supported enough to start allowing for self-reflection and contemplation of her situation. Most women victims have lived in a state of denial and self-protection as their partner exerted his (often subtle) ways of controlling her for many years. I therefore feel It is important that a medical doctor discuss the possibility of conjugal violence with every depressed women he or she sees.
By daala  Apr 09, 2012
31
I know from my personal experiences if my doctor had asked I may have felt like I had somewhere to turn. In my day to day life people knew what was happening and turned thier backs on it, thinking if it really was that bad I would leave. A person that has not experienced violence does not understand how it can parilyze you . If my doctor had asked I may not have disclosed but I may have felt that some one would believe me when I was ready to ask for help. There isnt always bruises and an abused person will always have an excuse to cover up for the various signs.
By lainey44  Mar 17, 2012
30
I want to answer Dr. Orrange's question. After reading some of the stories printed here, I think some effort should be made by medical people to raise the issue of intimate partner violence with the women they see as a constant routine. It's worth it even if a hundred women don't report it, if at least one brings it up and gets help.

Certainly if there are signs of stress, bruises, etc. the questions should be raised. There could be several levels, all preceded by the statement: this is a routine question we are required to ask every women who (comes in for a checkup, is pregnant, whatever your agency decides to put here). In addition, the staff could give each woman a short flyer about the information given here, some testimonies from women who finally got help, and the local phone numbers or web sites (such as this one) that they they can contact with their questions. The agency can even put on it something like: "if this doesn't apply to you, please pass it on to someone who does need it."
By joanelizabeth  Feb 27, 2012
29
So....the other side doesn't want to ask a few questions of all women, because it might not save enough women to make it worth their while? How many lives would make it worthwhile? If they only identify one, and save one, statistically it is not enough to make it worth asking the question of all?

Whatever can be done in any way to save as many people as possible, should be done. Abuse victims are often brainwashed that they deserved it, or that he's entitled to it. They are ashamed, and have no venue to begin to climb out of an abusive relationship. A doctor's office may be the only time they can speak to someone who might listen, and not have their abusive partner find out about it, and make them pay heavily for it.

Screening would save lives, and if it offends anyone to be screened in the interest of finding someone who is suffering from this, well....sorry. And, it's not a gender issue. It's a violence issue. If we can do something about it, it should be done.
By hockeymom5592  Feb 12, 2012
28
So....the other side doesn't want to ask a few questions of all women, because it might not save enough women to make it worth their while? How many lives would make it worthwhile? If they only identify one, and save one, statistically it is not enough to make it worth asking the question of all?

Whatever can be done in any way to save as many people as possible, should be done. Abuse victims are often brainwashed that they deserved it, or that he's entitled to it. They are ashamed, and have no venue to begin to climb out of an abusive relationship. A doctor's office may be the only time they can speak to someone who might listen, and not have their abusive partner find out about it, and make them pay heavily for it.

Screening would save lives, and if it offends anyone to be screened in the interest of finding someone who is suffering from this, well....sorry. And, it's not a gender issue. It's a violence issue. If we can do something about it, it should be done.
By hockeymom5592  Feb 12, 2012
27
I have been a victium of martial rape. When my husband gets drunk or mad he wants to have sex, I get physically ill and cry. Not the mention the other DV he inflicts on me, the degrading, the insults, the threats. I can't do anything right include breathing according to him
By Stuckinamess  Feb 08, 2012
26
Law enforcement has finally woken up to the fact that women and men batter one another equally. Up until recently, the feminists ran their con job and were able to get only the men arrested when the cops came out - even when his face was the one streaming with blood. But no more - now women are getting hauled off to jail. Hopefully Dr. Orrange will soon see the light.
By ESF  Feb 07, 2012
25
Domestic violence is a hard thing to deal with, legally.
I waz involved in D V (2x) with a previous boy friend. he immediately lied and told the police officers that I started the violence, so they didn't know who to beleve so they took both of us -- to jail. He looked worse than me because I could defend myself from him, physically. When I was released, I was asked if I wanted to press charges against him -- I couldn't!! I worked full time and during the day. I couldn't miss work to press charges against him to show up for court during the day.
There, that's how the system works.
By energylost  Feb 07, 2012
24
My Mom, would have never reported it, if she had been asked. Her life would have been more at risk (back in the 1950s). And as far as tody, then the child gets taken away and separated from the mom, which is good, but it's a cycle that is hard for the legal system to clean up -- at our expense.
By energylost  Feb 07, 2012
23
As mentioned previously, Kaiser "gets" that intimate partner violence is a mutual phenomenon, so they ask these questions to men patients, also. The University of Colorado Hospital *used* to frame this as a "for women only" question, until I set them straight by showing them the Fiebert compendium. So Kaiser and UC Hospital see the light, but you don't. Why is that, Doctor?????

Dr. O says:"This would mean asking questions about intimate partner violence to ALL of our female patients during their visits".
By ESF  Feb 06, 2012
22
I remember being on the other side of the desk in a situation like this. A tiny little old lady came in, and while she was at my desk, her big, slovenly adult son excused himself and went to the ret room. The woman leaned over my desk and whispered to me, "He's horrible to me! He makes me turn over my whole check to him, and if I don't, he hits me! I can't drive, I don't live anyplace where there is public transportation and I don't know what to do!" Junior came ambling back out about then. I didn't know what to do either. We lived in a very rural area. We didn't have women's shelters or facilities like that back then, and this guy was easily three times the size of my client. Junior wouldn't work so he was home all the time, and this poor woman was living in a situation tantamount to slavery. I didn't even dare refer her to Adult Protective, because they would visit, and then they would leave, and she would be in a worse mess than when they arrived. It was awful
By madbookworm  Feb 05, 2012
21
Even KAISER gets that domestic violence is gender-neutral, so what kind doctor only focuses on FEMALE victimization????!!!!
By ESF  Feb 05, 2012
20
After you see the Fiebert compendium, check out law professor Linda Kelly's paper: "Disabusing the definition of domestic abuse: how women batter men and the role of the feminist state". See it here:
http://www.law.fsu.edu/journals/law...
By ESF  Feb 05, 2012
19
WOMEN BATTER MEN AS OFTEN AS THE CONVERSE. Just when I thought you had swore off your feminazism, here you are back at it. Professor Martin Fiebert has compiled 18 pages of equal-perpetration reserach findings over the past 30+ years. (That's how long the media has covered up this research) See it here:
http://www.csulb.edu/~mfiebert/assa...
By ESF  Feb 05, 2012
18
it's not only women who are abused by their spouse. my wife abused me, divorced me and continues to abuse me. it's like I'm still married to me ex ands still get no emotional support from the arrangement. tried to go to counselors but they all assume the same thing you do, that it's the man's fault. meanwhile I have to watch my son getting more emotionally torn. but thanks for the concern, you are doing a great job.
By maittai  Feb 03, 2012
17
Sorry, re-read the article and saw that you were talking about primary physicians not OB-GYNs....
I do think there would still be a level of fear about telling, although probably not as intense as one would experience if they were pregnant.
I just think that regardless of who is doing the asking, a woman is not going to tell anybody until she is ready to tell. But I am not an expert, so whether that means that primary physicians shouldn't even try.......I don't know.
By Lilygirl27  Feb 03, 2012
16
Most women who are being abused do not want to tell. They are afraid of what will happen if they do. It just makes me fear that pregnant women will avoid getting pre-natal care if they fear that the abuse will be exposed at their office visits. They aren't going to want to risk upsetting their abuser and putting themselves and their baby in jeopardy. I have been abused. I have been lost in that cycle of being a victim and made to feel weak, and it takes a certain frame of mind to be able to stand up and admit what is going on. I am not sure a pregnant woman who fears for her child's safety would be able to do that. I know I wouldn't have. I would have lied. But I think it is good that this is being talked about. I am no longer with my abuser, by the way.
By Lilygirl27  Feb 03, 2012
15
I so appreciate everyones wisdom and honesty in these comments. Wow, DS.
By DrOrrange  Feb 03, 2012
14
Last I had heard it was 1 in 4, that saddens me that we are losing ground instead of gaining it. I think screening can't hurt even if it's only 1 in 100 that actually get help because of it, that is still 1% less, but not just the screening, but traing the doctors of both the signs of abuse and how to spot those who aren't being honest and how to help them hopefully find the courage to face their problem (the abuser)...
By KickingIT  Feb 02, 2012
13
I think we focus on the wrong partner when these things happen. Attention is focused on the abused partner, as though somehow they are the problem.

The problem is the abuser. This is a crime, and they are criminals. I don't see it as a social issue, it's an issue of criminal behavior and we need to look at the issue of why we are letting these abusers walk free.

Of course we should support the victims of crime any way we can. But the problem will only be solved when society stops tolerating this kind of criminal behavior. Until we change our thinking on this, these things will never stop happening.
By RichieD  Feb 02, 2012

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