An epidemic too often ignored

Posted Dec. 12, 2008, at 8:22 p.m.

I don’t care how many times I do it. I don’t care how fancy the medical degree of the person in the white coat across from me. I will never feel real comfortable talking to anyone about my bowel movements.

But at least once a year I do because during my annual exam my doctor asks me about them.

It’s a good thing because unless my issues in that area were pretty significant I would not bring up the subject voluntarily. Doctors and nurses know that. That’s why they ask us. Even though it’s embarrassing to talk about, we all know that sometimes even slight symptoms can be an indicator of something more serious.

Whether it’s a problem in our colons, our breasts or our genitals, we’ve all learned that keeping those symptoms secret can lend a whole new meaning to the phrase “dying of embarrassment.”

The same thing can be said when that “secret” is abuse in the home.

Every hour and a half a domestic assault is reported in Maine. So far, 18 people have been killed in domestic homicides here.

Domestic violence is and has been an epidemic that has significant impacts on the health and welfare of thousands of Maine families. Studies have recently confirmed the obvious, that children who witness violence in their homes are at increased risk of mental and emotional problems. Exposure to violence in childhood has been linked to increased rates of substance abuse, unintended pregnancy, depression, chronic illness and other disorders in adults.

If one wants to argue that domestic violence is not a “health care issue” then certainly the repercussions of it are.

Yet while doctors and nurses routinely ask you about what you eat, how you poop and how your sex life is, too many of them are not using the opportunities they have with you to ask how things are in your home.

This week Gov. John Baldacci and Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention, held a press conference to encourage health care providers to institute routine domestic violence screenings during routine medical visits.

It was a good thing to do and, truthfully, health care providers should have been doing it already.

The scourge of domestic violence and its devastating effects is not new information. We’ve been talking about this issue and educating professionals such as judges, police officers and doctors for many years.

Mills said earlier this week that many providers do ask those probing, if difficult, questions, but too many more do not.

That needs to change and the Maine Medical Association and Maine’s other leading health care institutions, such as its major hospitals, need to take a leading role in the effort to ensure it does.

If doctors, who do receive training on this issue and are encouraged to do the screenings as residents, are not doing them, then why not? Is it the extra time with the patient? Is it not knowing what to do with the information? Is it fear that the patient may be offended by such questions?

Eric Brown, a Bangor physician, has been talking to his patients about domestic violence for 20 years. He works with Physicians For Social Responsibility.

“I have screened for over 20 years and never has anyone been upset,” he told me this week.

Brown said studies done before the O.J. Simpson case showed that 75 percent of women felt it was appropriate for their doctors to ask about sexual violence and more than 85 percent felt it was appropriate for doctors to ask about physical violence in the home.

“Screening is still quite limited despite that we are trying to train residents better … If the numbers were this high with any other ‘medical’ disease, this issue would be aggressively researched and dealt with as an epidemic yet we can’t seem to get the docs on the front lines to give this issue the relatively short time it takes to screen and refer,” Brown said.

There are some pretty basic, well-worded questions that providers could ask their patients that, with time, would become as routine, as “What prescription medications are you currently taking?”

Is asking these questions going to catch every instance of domestic abuse? Of course not. But it’s another tool in the box. It will catch some. Somewhere, sometime, a scared woman who might not even have a bruise to show for the abuse she takes may decide at that very moment to tell. She may decide that even if she’s embar-rassed or afraid it’s time to tell this kind-faced and interested health care provider that she’s not safe.

Perhaps Dr. Brown and Dr. Mills, with the help and encouragement of our health care leaders, can finally convince other docs that saving that one woman might just be worth the time.

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