Health Care System
In addition to suffering injuries from physical attacks by their abusers, victims of domestic violence often suffer a wide range of health-related problems caused or exacerbated by the abuse, problems for which an apparent etiology is often lacking. Victims frequently present to the health care system with an array of complaints including, but not limited to, headaches and migraines, musculoskeletal complaints, fatigue, insomnia, anxiety symptoms such as palpitations and hyperventilation, gastrointestinal disorders, eating disorders, and chronic pain. In addition to these common complaints, victims of domestic violence may also be at increased risk of contracting HIV and other sexually transmitted diseases, of developing alcohol/other drug problems, depression, and suicidal ideation. Further, abusers' physical attacks often result in distinct injury patterns that are"red flags"for identifying abuse including, but not limited to, injuries during pregnancy, bilateral injuries, multiple injuries in various stages of healing, patterned injuries, defensive injuries, and fractures, particularly of the nose and eyes.
Despite the common clues and indicators of domestic violence that emerge in the health care system, research consistently indicates that a majority of health care providers fail to identify patients as victims and that this failure leads to a medical response that provides symptomatic treatment without addressing the underlying health threat-the violence. (22) Even when domestic violence is identified, it is often viewed as having little or no clinical significance. Without appropriate intervention, victims are at increased risk of developing serious, complex medical and psychosocial problems.
Research also indicates that battered women continuously seek help from the health care system and that health care providers are frequently the first or only professionals with whom they have contact. (23) Early identification, appropriate treatment, documentation, and referral of victims who seek health care may be one of the most effective ways to prevent repeated injury, pregnancy complications, and the multiple medical and psychosocial sequelae associated with ongoing abuse.
The health care system is itself a vast array of systems including, but not limited to, emergency medical services, medical transport services, hospitals, clinics, private practitioners including dentists, obstetricians, and gynecologists, managed care organizations (HMO's), county public health agencies, home health care providers, visiting nurse associations, rehabilitation centers, and veterans' health facilities. It is critical that all segments of the health care system respond appropriately and consistently. Many times, victims will be seen solely by one part of the system, such as emergency medical services. At other times, they may receive an array of health care services, such as from hospitals, health maintenance organization clinics, and private practitioners. It is crucial that