Indicators of abuse may be overt injuries or may be more subtle physical complaints. The physical indicators of abuse include a variety of injuries in different stages of healing, injuries, which are inconsistent with the reported cause, and the presence of multiple injury sites. More subtle signs may include anxiety, depression, panic attacks, substance or alcohol abuse. Almost any chronic physical complaint that remains refractory to treatment or where no pathology can be demonstrated should raise the suspicion that domestic violence may be a factor.
In examining women, practitioners should be aware of common injury sites e.g. head and neck, face, throat, chest and abdomen. In pregnancy injuries to the abdomen and breasts seem to be more frequent. Careful full examination should occur where the suspicion of violence is raised.
Documentation must be carried out carefully but objectively. If agreeable to the woman, photographs may be taken or location of injuries may be indicated on a body map. Comments on the woman’s emotional state may help to clearly draw a picture for the authorities when written at the time of the encounter rather than recalled in retrospect. Remember that good documentation may help both the woman and you if this situation comes before the courts. If the documentation is clear and objective it may minimize the time required for testimony or may obviate the need for testimony completely.
As physicians, we may feel that it is difficult to cope with the issue of domestic violence; however, with only a few basic tools we can be part of a solution rather than part of the problem.