The crisis within the crisis: How any physician can help stop domestic abuse in its tracks

By Physician Sense
Published May 1, 2020

Key Takeaways

You’ve trained to spot signs of domestic abuse and violence during patient encounters. But can you do it when the patient isn’t in the room with you?

As lockdowns and quarantines have forced millions to stay home, many find themselves cut off from their usual support system of friends, family, and social services. As a result, survivors of domestic abuse and domestic violence increasingly feel helpless. 

A recent Kaiser Permanente report highlights how historically, during natural disasters, incidences of domestic abuse and violence have gone up. This is supported by a 2013 literature analysis published in the Journal of Research in Medical Sciences. There, researchers wrote:

“The results of these studies reveal that being exposed to natural disasters such as tsunami, hurricane, earthquake, and flood increases the violence against women and girls, e.g., rape and sexual abuse, intimate partner violence, child PTSD, child abuse, and inflicted traumatic brain injury.”

This trend played out during Hurricane Katrina. A Catholic Charities report indicates that instances of domestic violence increased by 45% in New Orleans after the hurricane. Additionally, a 2009 study published in Disaster Medicine and Public Health Preparedness found that in Mississippi, instances of gender-based violence among women increased from 4.6/100,000 to 16.3/100,000 within a year of Hurricane Katrina. While not a natural disaster per se, the current pandemic has presented similar circumstances: As the fight against COVID-19 rages on, many are forced to spend an unprecedented amount of time in close quarters with their abusers. 

So, how can you help? Physicians have a vital role to play in aiding these victims, the experts interviewed for this post say. And telehealth visits provide a critical opportunity for doctors to disseminate potentially lifesaving information.

Dr. Jasmine Constanzo, D.O., is a California-based physician in private practice. In an exclusive PhysicianSense interview, Constanzo offered insights as to how doctors can assist domestic abuse victims in telehealth settings. Her expertise on the topic of domestic violence stems from her residency at a level-one trauma center in the Bronx, where she saw numerous cases.

Amplifier effect

Constanzo says that the circumstances of COVID-19 can be nightmarish for survivors.

“This is a time when any relationship dysfunction that’s already there is going to be amplified,” she says. “During telehealth visits, we have the opportunity to discover things that are coming to fruition.”

Constanzo says there are common indicators physicians should note, including the outward signs of physical abuse. But oftentimes, the signs require a more discerning eye to spot.

“One of the things you often see with domestic abuse is that the abused person feels trapped,” Constanzo says. “The abuse may take the form of physical coercion or violence, and it could also be emotional. A lot of times, physical abuse is not the most common presentation. It’s emotional abuse and disempowerment — a constant cycle of that punctuated by physical abuse.”

During a telehealth visit, these indicators may take the following forms: 

  • Excessive apologizing

  • Refusal to make eye contact

  • Unwillingness to discuss symptoms

  • Explaining away pain as the result of something they did

  • Fidgeting or other signs of discomfort

What physicians can do

Researchers and advocates are still gathering data on domestic abuse and domestic violence, however, early indicators point to an increase in both. Lisa James, the Director of Health at Futures Without Violence, says field reports indicate precisely that.

“You might see in the media that calls to different state or local hotlines for domestic abuse have gone down, but texting or chat requests for support have gone up,” James says. “Law enforcement are expressing concern because they think that people don’t feel safe enough to reach out.”

And patient safety, James says, is paramount during this time when survivors may have little or no privacy. That’s why her organization is recommending that physicians pivot from specifically screening for domestic violence to educating and providing resources on the topic.

“In a telehealth setting, we just don’t know enough about the patient’s privacy and safety,” James says.

An abuser could be listening in, checking messages and emails, or even reviewing web browsing history. That’s why Futures Without Violence is recommending that during telehealth visits, physicians:

  • Make sure the patient is in a secure, private space. If none is available, encourage the patient to go for a walk.

  • Do not screen for domestic violence but educate on the topic and provide resources. James says you might say something like, “We know that everybody is struggling with the pandemic, and sometimes stress can impact our relationships. I want to share some free confidential help available for you or someone you know, who might be being hurt in their relationship.”

  • If a patient is concerned about their texts or web browsing being read, physicians can tell them how to clear both.

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