Domestic violence: a life-span approach to assessment and intervention.

Domestic violence affects millions of Americans, many of whom deny or refuse to admit that that they are victims of abuse. Assessing patients at risk for domestic violence is a critical aspect of providing comprehensive primary care. As social agents, with moral and ethical responsibility, primary care providers must advocate for clients in the fight against domestic violence. Primary health care agencies must adopt uniform policies that assure that all women, children, and elders at risk for abuse are screened using a simple tool that becomes part of the primary care record. Screening for abuse should become part of an annual screening process, not unlike screening patients for high blood pressure or high cholesterol. If patients are suspected of being abused, document this on the problem list so subsequent providers will know to explore the possibility of abuse with patients. Multiple forms of abuse occur in families, and signs of abuse are usually subtle in nature. Abuse may be the reason for failed office visits, noncompliance with medications, depression, and other unexplained physical and psychological signs and symptoms. If we fail to ask, we will never know how many of our patients are victims of abuse and in need of our help.