Because of its prevalence and medical consequences, abuse must be considered by physicians in the differential diagnosis for a number of medical complaints, particularly when treating women, children, and elderly persons.
Physicians who are likely to have the opportunity to detect abuse in the course of their work have an obligation to familiarize themselves with (1) protocols for diagnosing and treating family violence, (2) state reporting requirements and protective services, and (3) community resources for victims of abuse.
Physicians also have a duty to be aware of societal misconceptions about family violence and prevent these from affecting the diagnosis and management of abuse. Such misconceptions include the belief that abuse is a rare occurrence; that "normal" individuals are not abusive; that family violence is a private problem best resolved without outside interference; and that victims are responsible for abuse.
The medical profession must demonstrate commitment to ending family violence and helping its victims. Physicians must play an active role in advocating increased services for victims and abusers. Protective services for abused children and elders need to be better funded and staffed, and follow-up services should be expanded. Shelters and safe homes for battered women and their children must be expanded and better funded. Mechanisms to coordinate the range of services, such as legal aid, employment services, welfare assistance, daycare, and counseling, should be established in every community. Mandatory arrest of abusers and greater enforcement of protection orders are important law enforcement reforms that should be expanded to more communities. There should be more research into the effectiveness of rehabilitation and prevention programs for abusers.
Informed consent for intervention should be obtained from competent victims of abuse. For minors who are not deemed mature enough to give informed consent, consent for emergency interventions need not be obtained from their parents. Physicians can obtain authorization for further interventions from a court order or a court appointed guardian.
Physicians should inform patients of a child abuse diagnosis and they should inform an elderly patient's representative when the patient clearly does not possess the capacity to make health care decisions. Safety of the child or elderly person must be ensured prior to disclosing the diagnosis when the parents or caretakers are potentially responsible for the abuse. For competent adult victims, physicians must not disclose an abuse diagnosis to caregivers, spouses or other third party without the consent of the patient. (JC Rpt F, A-93) (Reaffirmed A-17)
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Abbreviations for House of Delegates report origination:
EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services