Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, March 19, 1995 TAG: 9503180012
SECTION: HORIZON PAGE: G-1 HORIZON EDITION: METRO
SOURCE: ELIZABETH FERNANDEZ SAN FRANCISCO EXAMINER
DATELINE: SAN FRANCISCO LENGTH: Long
Some women fabricated tales to explain their injuries, telling a doctor they ``walked into a door,'' a transparent lie but one readily accepted by the doctor.
Other women said their physicians were simply too busy ``to help battered women.''
In a harsh indictment of the medical care system, a new University of California-San Francisco study says that doctors may be quick to bandage a battered woman but fail to treat the real cause of her wounds.
The study found doctors were often uncomfortable treating victims of domestic abuse, wary of interfering in what they considered private matters, or believing their job was simply to patch up the patient without further probing.
``We're trying not to doctor-bash,'' said Barbara Gerbert, one of the study's authors and head of UCSF's Division of Behavioral Sciences. ``But the study shows that change is needed and that the whole health care system needs to improve.''
The O.J. Simpson case has brought domestic violence to the forefront of public attention.
Yet the role of doctors - who along with police play one of the most critical roles in helping battered women - has been largely ignored.
Increasingly, women's advocates and doctors themselves are urging significant changes within the health care profession.
``Some physicians feel this is not a health issue, but a social issue that should be dealt with by police,'' said Dr. Michael Rodriguez, a family physician at San Francisco General Hospital and director of the Violence Prevention Task Force. ``But this is an incredible problem, one of the most significant health problems that women face today.''
The epidemic of violence afflicts an estimated 2 million to 4 million women in the United States, causes 21,000 hospitalizations and has an estimated medical cost of more than $44 million every year.
Dr. Robert McAfee, president of the American Medical Association, said that domestic abuse is as critical a public health crisis as AIDS, smoking and illegal drug use.
Too often, McAfee said, doctors focus only on a woman's broken nose or twisted ankle, or, worse, they brusquely order her to leave her partner, instead of taking the time to understand the intricacies of her dilemma.
``Patients look to their physician to be helpful,'' McAfee said. ``Given this ominous responsibility, how are we doing?'' The answer, said McAfee, is that doctors don't recognize the signs of domestic violence more than 90 percent of the time.
The medical profession, McAfee said, must undergo a quantum shift in attitude, shed discomfort and ask patients about a history of domestic violence.
``It's awkward for physicians who trained 20 years ago,'' McAfee said. ``It's the same awkwardness we had to go through when the sexual revolution hit the country and the drug revolution.''
Legislation is helping to do just that.
Starting this year, California became the first state in the country to require that domestic violence training be part of a medical education program for doctors renewing their licenses.
Other states are expected to follow.
California also now requires doctors to report their suspicions of domestic violence to law enforcement officials.
But that's not enough, say those who work in the domestic violence field.
Only 1 in 20 women who are victims of abuse are being identified as such by their doctors, said Ariella Hyman, an attorney at the San Francisco Neighborhood Legal Assistance Foundation.
``Women are not getting the critical help they need,'' said Hyman, who trains health care workers about domestic abuse.
One national organization, however, headed by Dr. Patricia Salber, who has spent 15 years as an emergency-room physician at Kaiser Permanente in San Francisco, is trying to train doctors to better treat battered women.
Called Physicians for a Violence-Free Society, the 600-member Dallas-based organization teaches doctors about the crime.
``When I was in medical school in the '70s it was simply not taught. Society simply didn't talk about it,'' said Salber. ``There were cases I couldn't figure out, where women would come in to the emergency room at 2 or 3 in the morning with chronic abdominal pain or chronic pelvic pain. But no one told us we ought to ask.
``Doctors can be the first crack in the darkness,'' she said.
For their part, battered women have a litany of reasons not to confide in their doctors, said San Francisco General's Michael Rodriguez, who has studied the issue for three years. The reasons are: shame, embarrassment, fear of police involvement and fear that the abuse will escalate.
``Some women say their physicians are so wrapped up in their paperwork they don't look them in the eye,'' Rodriguez said. ``That makes them feel the doctor doesn't care.''
Doctors and patients must form a partnership, said Debbie Lee, associate director of the Family Violence Prevention Fund in San Francisco, which has done pioneering work to improve the health care system's approach to domestic violence. Women must confide in doctors, she said, and doctors in turn must ``tell victims they don't deserve to be beaten.''
Lee said physicians must also document a victim's injuries for possible future prosecution.
``If the cycle is to stop, doctors need to let her know there is assistance out there,'' she said.
by CNB