R = Routinely Screen Patients
A = Ask Direct Questions
D = Document Your Findings
A = Assess Patient Safety Additional Resources
R = Review Options and Referrals
R = Routinely Screen Patients
Although many people who are victims of domestic violence will not volunteer any information, they will discuss it if asked simple, direct questions in a non-judgmental way and in a confidential setting.
Interview the patient alone.
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Sample questions: - “Are you in a relationship in which you have been physically hurt or threatened?” If not, “Have you ever been?”
- “Have you ever been hit, kicked or punched by your partner?”
- “Do you feel safe at home?”
- “I noticed you have a number of bruises; did someone do this to you?”
If the patient answers “yes:"
Encourage the patient to talk about it. Ask:
- Would you like to talk about what has happened to you?”
- “How do you feel about it?”
- “What would you like to do about this?”
Listen non-judgmentally. This serves both to begin the healing process for the patient and to give you an idea of what kind of referral the patient may need. Validate the patient’s experience by saying:
- “You are not alone.”
- “No one has to live with violence.”
- “You do not deserve to be treated this way.”
- “You are not to blame.”
- “What happened to you is a crime.”
- “Help is available to you.”
If the patient answers “no,” or will not discuss the topic:
Be aware of any clinical signs that may indicate abuse:
- Injury to the head, neck, torso, breasts, abdomen or genitals
- Bilateral or multiple injuries
- Delay between onset of injury and seeking treatment
- Explanation by the patient which is inconsistent with the type of injury
- Any injury during pregnancy, especially to abdomen or breasts
- Prior history of trauma
- Chronic pain
- Symptoms for which no etiology is apparent
- Psychological distress such as depression, suicidal ideation, anxiety and/or sleep disorders
- A partner who seems overly protective or who will not leave the person’s side
If any of these clinical signs are present, ask more specific questions. Make sure he or she is alone.
- “It looks as though someone may have hurt you. Can you tell me how it happened?”
- “Sometimes when people feel the way you do, it may be because they are being hurt at home. Is this happening to you?”
If the patient denies abuse, but you strongly suspect it:
- Document your opinion.
- Let the patient know there are resources available should he/she choose to pursue such options in the future.
- Make a follow-up appointment to see the patient.
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Record a description of the abuse as the patient has described it to you. - Use statements such as “the patient states she was …”
- If they give the specific name of the assailant, use it in your record. “She says her boyfriend John Smith struck her …”
Record all pertinent physical findings.
- Use a body map to supplement the written record.
- Offer to photograph injuries.
- When serious injury or sexual abuse is detected, preserve all physical evidence.
- Document an opinion if the injuries were inconsistent with the patient’s explanation.
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Before the patient leaves the medical setting, find out if he/she is afraid to go home.
- “Has there been an increase in frequency or severity of violence?”
- “Have there been threats of homicide or suicide?”
- “Have there been threats to their children?”
- “Is there a weapon present?”
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If the patient is in imminent danger:
- Find out if there is someone with whom he/she can stay. “Do you need immediate access to a shelter?”
- Offer the opportunity of a private phone to make a call.
If the patient does not need immediate assistance:
- Offer information about hotlines and resources in the community. Remember that it may be dangerous for the patient to have these in his/her possession. Do not insist that he or she take them.
- Make a follow-up appointment to see the patient.
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For more information or additional copies of this document please contact the Pennsylvania Medical Society's Member Services Department at (800) 228-7823.
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