b'AWARENESS GUIDE|were once married. She had to get surgi-Domestic Violence Protocols: cal repair as well as legal and mental health Dos and Donts [treatment].All healthcare facilities should also have D ealing with the issue of domestic violence, or even a potential patient situ- signage that signals to patients that they can ation involving intimate partner violence, requires an extra level of care andbring up such sensitive subjects, she says, discretion. The Rural Monitor offers a list of dos and donts for healthcareadding that SUNY facilities include such providers. For example: signs, as well as continuous videos that Dos encourage patients to ask about subjects like domestic violence if they werent asked by Normalize screening as confidential and applying to all women, because of their care providers. domestic violences overall health impact. For example, a provider might say,All on the healthcare team were edu-I dont know if this is a problem for you, but many of my/our female patientscated on how to handle suspected domes-are in relationships where they dont always feel safe. tic violence, recognizing that different Use gender-neutral terms with specific questions, such as Has your partnerpatients have their preferences [in termsever hit, choked or physically hurt you? of] whom they feel comfortable sharing the information.Remember that it takes courage to disclose, so repetitive screening is Part of a new patients medical his-important.tory should include asking sensitive ques-Remember the danger associated with leaving a domestic violence situation.tions, including those concerning domestic Recommend a follow-up visit.violence.Donts Part of the education [of providers at SUNY] is to say, I have to ask you some sen-sitive questions, so they do that first, says Dont bury screening in a checklist of other screening items, such as Do you use sunscreen? Do you feel threatened? Do you wear seatbelts? Sweeney. Dont avoid eye contact when asking screening questions.Framing statements, for example, help build rapport with patients, and increase Dont force disclosure. their comfort with discussing the violence theyve endured. Providers can tell patients, for instance, that Reference theyve begun to ask all patients about abuse,ural Health Information Hub, 2018. Accessed September 13, 2020.as its so common in many peoples lives. R[https://www.ruralhealthinfo.org/rural-monitor/domestic-violence/] Or, a provider can inform a patient that past experience has led them to be con-cerned that some of their behavioral health been linked to various health issues such asDownstate Medical Center, urges healthcarechallenges might be the result of domestic arthritis, asthma, migraine headaches, irri- providers to take off their stereotype glassesviolence, and follow this statement by asking table bowel syndrome and nightmares, aswhen assessing whether a patient is a victim ofthe patient if this is true. well as mental health problems. 1 domestic violence.And, straightforward screening questions Of course, healthcare professionals canDont do the eyeball test, says Sweeney.can include:play a pivotal role in helping victims of inti- All peoplerich, poor and in between, allAre you in a relationship with a person mate partner violence, and experts say careraces, nationalities, religions, genders, sex- who physically hurts you or threatens you?providers must know the proper protocolsual orientation and agescan be victims ofDid someone cause these injuries? Was it for the screening of and response to occur- domestic violence.your partner/husband?rences of domestic violence. 4 Healthcare professionals must alsoDo you ever feel afraid of your partner? understand the history of different types ofDo you feel you are in danger? Do you feel ASSESSING FOR SIGNS OF DOMESTICdomestic violence, she adds.like its safe for you to go home?VIOLENCE Im reminded of one patient in particularSupportive statements also help increase Monica Sweeney, MD, MPH, FACP, a publicwho once came to the gynecology depart- patients comfort level. These can include health consultant and professor emeritus inment, continues Sweeney. She had beenletting a patient know that it wasnt their the department of health policy and manage- raped by her ex-husband, but didnt knowfault, and asking what they, as a healthcare ment in the School of Public Health at SUNYit was domestic violence, because theyprofessional, can do to help. 14 AWARENESS GUIDE|2020| www.elitecme.com'