Pediatrics protocol uncovers family violence

When pediatricians routinely ask young patients' parents or caregivers about domestic violence, they are more likely to detect those who need additional services to deal with this problem, according to a study published in last month's Pediatrics.

"If you ask, you will find," said Teresa Holtrop, MD, lead author and assistant professor in the Carman and Ann Adams Dept. of Pediatrics at Wayne State University and the Children's Hospital of Michigan, both in Detroit.

Researchers implemented the partner violence screening protocol at the hospital's general pediatric clinic in March 2002. They asked three questions: first, a question about being punched or kicked; second, how safe a person feels in his or her current relationship; and third, if he or she feels threatened by someone from a previous relationship.

In the year following, the social work department received 164 referrals from physicians because of a positive screen, a significant increase from the nine received the year before the project began. The authors concluded that a formal, routine screening can increase referrals as well as documentation of previous unrecognized problematic home situations.

For anti-violence advocates, this is one more study adding to the body of literature indicating that physician involvement is important. Several medical associations, including the American Academy of Pediatrics and the American Medical Association, encourage physicians to inquire routinely about family violence histories, discuss safety issues, be familiar with local resources and make appropriate referrals.

"I'm disappointed to see the numbers, but I'm pleased to see the process," said Robert McAfee, MD, a former AMA president who has long been concerned about the issue. "It is the ethical imperative of physicians to seek out family violence and to provide assistance, counseling, referral, whatever is appropriate for that particular situation."

Experts did concede, however, that while there is significant evidence that those who are abused want their physicians to ask and that asking may lead patients to additional services, there is still no evidence that this actually leads to improved outcomes.

"It doesn't mean that [it] doesn't make a difference. We just don't have the evidence," said Dr. Holtrop. "But it's still the right thing to do."