Almost a quarter of all women experience violence in their lives that affects their health: they are raped, abused or sexually assaulted. For the most part, these violent assaults take place in the “social near field.” Domestic violence is one of the greatest health risks for women in Germany – nationwide. And 95% of the victims of domestic violence are women, regardless of whether it is subtle forms of violence through behavior that ignores the needs and sensitivities of the victim, or humiliation, insults and intimidation, as well as psychological, physical and sexual abuse, including rape and homicide. While acts of violence do occur in same-sex relationships, they are as insignificant in number as violence by women against men in a relationship.
Hopeless situation?
Victims of domestic violence often feel their situation is hopeless:
- Instead of security, they experience violence, because the perpetrator is or was a loved one.
- Threat, isolation and control by the violent partner unsettle and shake self-esteem.
- Almost always, children are also affected; therefore, all follow-up decisions are often accompanied by concerns about “taking away a parent” from the children if one decides to separate.
- Financial dependencies between the victim and the perpetrator, as well as the lack of economic prospects, make the step to separation more difficult.
Point of contact doctor
Women who experience domestic violence often keep quiet about what they have experienced and, for numerous reasons, are rarely willing to report it to the police or turn to a counseling center. However, they do make use of emergency rooms, gynecological and general medical practices to get care for their injuries. Doctors are therefore often the only and usually the first point of contact for women who have suffered violence. Yet hardly any physicians have learned in training or continuing education what to look for in a patient in whom they suspect violence is behind the symptoms.
Perceive violence
In this regard, physicians are challenged in two ways: They must also perceive their patients’ injuries and symptoms from the point of view of “domestic violence,” and they must allow for and be aware of the possibility of experiencing violence in the first place. This is especially important because long-term consequences of violent assaults can often manifest themselves in chronic, psychological and pyschosomatic complaints. Anxiety, long-lasting sleep disorders, eating disorders, addiction risk, persistent gynecological complaints can be just as much a consequence of violence against women as hematomas, knocked-out teeth, broken bones or injuries in the genital area.
Treat health consequences
In addition, physicians must be able to adequately treat and document the injuries and subsequent health effects so that this documentation can be used as evidence. The treating physician/doctor must be able to conduct the conversation with the abused woman in a sensitive manner and provide solutions or further avenues.
Finding the right approach
In the rarest of cases, women bring up the violence that has been done to them themselves. But research shows that they find it a relief to be addressed by the health care provider. Subtle hints, such as the display of appropriate information material in the waiting room, can indicate to the traumatized patient that her doctor is aware of the problem of domestic violence. In the Federal Republic of Germany, there have been attempts for some time to make physicians more aware of the issue of domestic violence. For example, the “Signal” intervention project in the first aid station of the Benjamin Franklin University Hospital in Berlin provided scientific support for an approach to better prepare medical professionals. It was found that 63.9 percent of the women surveyed believed that anamnesis should generally ask about violence they had experienced. Only 4.6 percent of the affected women found this question unnecessary. For the interview itself, a quiet environment should be chosen in which interruptions are avoided. Under no circumstances should the patient’s honesty be questioned or any attempt made to minimize the incident.
