A Honolulu doctor’s crusade to end domestic violence.
It is hard to imagine that, as recently as 30 years ago, hitting your wife was considered a private matter. (In fact, in the 19th century, many courts exempted husbands from assault and rape statutes.) Today we know that men, too, can be victims of domestic violence; men make up about 10 percent of abuse cases. Through lobbying efforts begun in the 1960s, domestic violence was criminalized. Congress passed the Violence Against Women Act of 1994 and 2000. The Honolulu Police set up the Family Violence Detail Unit. The Honolulu City and County now has 15 of its 105 prosecuting attorneys working full time on domestic violence. The U.S. Department of Justice started a Violence Against Women Office, and has given out more than $1 billion in STOP grants to states to set up programs to reduce domestic violence.
Yet despite an extensive public campaign, it has been estimated that only around 25 percent of battered women report their abuse to the police. Less than 50 percent of abused women will seek treatment in a clinic, emergency room or hospital. They made an estimated 25 percent of emergency room visits and 10 percent of clinic visits in the past year. Many of them will not say directly that they are being abused. "I see women with injuries coming in with their husbands," according to Dr. William Lee at Straub Emergency Department, "and they will say that they fell down and cut themselves."
Battered women are more likely to have chest pains, gastrointestinal symptoms, gynecological problems, headaches, back pain, depression, anxiety and insomnia. Thirty percent of battered women attempt suicide, compared to 4 percent of non-victims. Interestingly, in a study conducted at the Vancouver General Hospital in Canada, battered women were also more willing to use programs if they were labeled "medical services" rather than "domestic violence services."
All of this is why domestic violence is now viewed as not just a violent crime, but also as a public health problem. All major medical societies now recommend that doctors and nurses screen patients for domestic violence, but surveys show that few doctors routinely do so.
Dr. William Parker, of The Queen's Medical Center in Honolulu, is trying to change that. He is working with the Department of Health, the Hawai'i State Coalition Against Domestic Violence and the University of Hawai'i medical school to make doctors more comfortable with screening and counseling patients for domestic violence. As a practicing gynecologist, educator, researcher and women's advocate, Parker gives a lecture every year to the third- and fourth-year medical students at the University of Hawai'i, as well as a Grand Rounds Lecture for the internal medicine residents at Queen's.
"I think the best way to screen for domestic violence is to make it routine. I try to integrate it into the annual physical," Parker explains.
Indeed, battered women value direct questions about their abuse by physicians and other healthcare workers. They appreciate confidentiality, and a doctor or nurse who listens carefully and reassures the woman that the abuse is not her fault, that her feelings of shame and fear, anger and depression, are not only understandable, but also appropriate in her situation. Abused spouses are grateful to be given referrals to appropriate agencies, such as Child and Family Service, Domestic Violence Clearinghouse, Parents and Children Together and Joint Military Family Abuse Shelter.
If a woman admits to being a victim of domestic violence, healthcare workers should support the woman, advise her to have a safety plan (have cash and personal documents handy) and refer her to services, such as Pu'uhonua, a domestic abuse response team, at 522-5535, or the National Domestic Violence Hotline, at 800-799-SAFE. It is also important to ask her, "Are you safe to go home?"
"I would like to see a domestic violence advocate who is dedicated to the local hospitals and clinics, who can back up doctors and nurses," Parker adds. "For example, if you screen a woman in your clinic for domestic abuse, and she tells you she does not feel safe returning home, what do you do then?"
"I think that as a society, we do not feel comfortable screening for domestic violence," observes Parker. "Especially here in Hawai'i, we are very polite. You might have to ask a women three or four times."
Author's Note: Dr. Robert Yih-jen Shaw is an internist at Straub Clinic and Hospital. He trained at Albany Medical College, the University of Hawai'i and Oregon Health Sciences University. His last piece for HONOLULU Magazine was "How to Choose Your Doctor," July 2004.