Domestic Violence Conference

The lovely coordinators of the DV Conference

Today I attended an all-day Domestic Violence (DV) Conference held at UCSF. It's amazing to think that incredible conferences on topics ranging from cancer imaging to universal healthcare to domestic violence happen every weekend on campus. It blows my mind.

Domestic violence is a healthcare issue...here are some facts from the "Family Violence Prevention Fund" (FVPF), funded by the U.S. Department of Health and Human Services:

- "Nearly one-third (31%) of American women report being physically or sexually abused by a husband or boyfriend at some point in their lives.
- In 2000, 1,247 women, more than three per day, were killed by their intimate partners.
- In addition to injuries sustained during violent episodes, physical and psychological abuse are linked to a number of adverse physical health effects including arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, and stomach ulcers.
- Children who witness domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety, and violence towards peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution, and commit sexual assault crimes.
-Emerging research indicates that hospital-based domestic violence interventions will reduce health care costs by at least 20%.
- A recent study found that 44% of victims of domestic violence talked to someone about the abuse; 37% talked to their healthcare provider. Additionally, in four different studies of survivors of abuse, 70-81% of the patients studied reported that they would like their healthcare providers to ask them privately about intimate partner violence (IPV)."


So many issues are swirling around in my head, but what strikes me the most is how the concept of domestic violence and the issues surrounding it can have similarities to so many other ideas in healthcare:
- Like obesity or smoking, domestic violence is a multifactorial health problem that leads patients to suffer from physical injury, emotional trauma, and stress-related symptoms. Prevention of domestic violence at an early stage would not only save the lives of countless women, but would also save the healthcare industry a fair amount of money in the long run due to abolishment of the "revolving door" for abuse victims in the ER that currently exists in many places.
- Domestic violence is like "second-hand smoke" in that it not only harms the abuse victim, but also the children and family members living in the same household. These children also suffer from physical and emotional health problems and engage in behavior that may endanger their health.
- Pharmacists have a unique role because abuse often centers around issues of control, and medication and birth control becomes prime examples of how abusers can maintain power over their victims.
- Doctors, nurses, and other healthcare professionals also have to be aware of "compassion fatigue" and "secondary or vicarious trauma" that can result from helping victims of domestic violence. Burn-out is a common hazard. I feel that the issues of compassion fatigue and burn-out are also very pertinent issues in oncology and hospice care that are rarely addressed by the healthcare community.

As a medical student, the most important lesson that I learned today is to ALWAYS ask about domestic violence in a private and safe environment during the clinic appointment. It seems like a simple protocol, but doctors rarely screen their patients in this manner and it makes all the difference.

To draw another parallel to a similar health issue, doctors also rarely question patients about depression and thoughts of suicide. The general stance is that doctors should always always ask...but physicians and medical students rarely do. When interviewing a double-lung transplant patient during my Foundations of Patient Care class, I asked the female patient dozens of questions during a one-hour session. She answered in short sentences and rarely volunteered any information, and I felt frustrated and helpless and maddened by the fact that she expressed ignorance on every issue, including why she had the lung transplant in the first place. Later on, during my clinical interlude in psychiatry, I stumbled upon this patient's name and discovered that she was suffering from major depressive disorder. Did I detect this during my hour-long interview? Did I even ask her whether she was feeling depressed? No...and that has made all the difference in changing my attitude and approach.

Lesson learned.