Q: I recently saw a young woman with a badly bruised eye. She told me she “ran into a door.” I suspect domestic violence. What is the best way to try and get to the bottom of this?
A: “There are a number of warning signs of domestic violence of which we as optometrists should be aware,” says Jessica Young, O.D., of Johnstown, Pa. Be alert for:
- Chronic, vague complaints with no obvious physical cause.
- Injuries that do not match the explanation of how they occurred.
- Delays between injuries and seeking treatment.
- A partner who is overly attentive, controlling or unwilling to leave the patient’s side.
You can ask indirectly: “Your symptoms may be related to stress. Do you and your partner tend to fight a lot? Have you ever gotten hurt?” Or ask directly: “Sometimes when I see an injury like yours, it’s because somebody hit them. Did that happen to you?”
Know How to Report Domestic Violence in Your State
Include a simple screening question on your patient intake form, says Cheryl Landry, O.D., J.D., of the VA Boston Healthcare System. For example, “Are you currently or have you ever been in a relationship where you were physically hurt, threatened or made to feel afraid?”
If a patient says she is a victim of domestic violence (although men can be victims, too), respond appropriately and offer supportive, nonjudgmental care. “Acknowledge her feelings and recognize the injustice,” Dr. Young says. “The patient needs to know she is not alone and that the violence perpetrated against her is wrong.”
One important way to help: Carefully document injuries. “If the medical record is accurate and comprehensive, it may qualify as objective evidence in court proceedings—a restraining order, for example—or facilitate access to public housing, welfare or other assistance,” Dr. Landry says.
To create a medical record that is legally sufficient for use in court, she says an optometrist should:1
- Write legibly.
- Photograph the patient’s injuries.
- Stick to the facts and use medical terms for documentation.
- Use quotation marks or the words “patient states” to indicate the patient’s own statements.
- Avoid language that implies doubt about the patient’s reliability (e.g., “patient claims” or “alleges”).
- Record a description of the patient’s demeanor (e.g., crying, fearful, etc).
- Record the time of day of the exam and when the injury occurred.
- Avoid conclusory statements or legal terms (e.g., “patient is a domestic violence victim”).
Q: What is my legal responsibility in reporting situations involving either an adult or a child?
A: “Laws vary by state, but most states have enacted mandatory laws that require health care professionals to report specified injuries and wounds, suspected abuse or domestic violence, or if the injury was the result of a crime,” Dr. Young says.
“All 50 states have passed child abuse mandatory reporting statutes, and most states have mandatory reporting of elderly abuse,” Dr. Landry says. “If you have problems locating the applicable laws, consult with your attorney, your state optometric association or state optometry board.”
1. Isaac NE, Enos VP. Documenting Domestic Violence: How Health Care Providers Can Help Victims. Rockville, MD: National Institute of Justice, Research in Brief; 2001 Sept: 3-4. Available at: www.ncjrs.gov/pdffiles1/nij/188564.pdf.