Professional Issues

Professional issues at the individual level involve those related to health care professionals’ roles and functions. Among the primary issues affecting individual response to family violence are time, inadequate training, uncertainty about how to respond, perceptions of patient noncompliance, and inadequate incentives for involvement.

Many health care providers feel they lack sufficient time to adequately assist victims of abuse. In one survey (Sugg and Inui, 1992), 71 percent of physicians interviewed stated that time constraints were a major reason they refrained from asking patients questions about family violence. Primary care practitioners frequently chose to refrain from involvement because they felt that the issue would consume their already limited time. One physician said (Sugg and Inui, 1992):

I think that some physicians, and I do the same thing, if you are very busy and have lots of patients waiting, you just don’t ask a question that you know is going to open a Pandora’s box. Even if it crosses your mind, you don’t ask. (p. 3158)

Many primary care physicians were frustrated with what they perceived as an “extra” societal responsibility, stating that they could quickly become overwhelmed in caring for “nonmedical” issues (Sugg and Inui, 1992). For example, in one survey, an estimated 37 percent of California primary care physicians cited lack of time as a major barrier to the identification and referral of patients experiencing intimate partner abuse (Rodriguez et al., 1999). Nevertheless, in a study of Alaskan physicians who provide prenatal care, time constraints were not associated with differences in screening rates (Chamberlain and Perham-Hester, 2000).

Even if time were not an issue, health care providers have expressed concerns regarding inadequate preparation, uncertainty about how to proceed if maltreatment is disclosed, and frustration with the inability to ensure positive outcomes for the victims. For example, one study indicates that many health professionals believe they have not had adequate medical education or training on intimate partner violence (Reid and Glasser, 1997; see also Chapter 3, this volume). In another study of emergency room physicians, an existing protocol recommended referral of victims of intimate partner violence to a social worker or mental health professional and also listed referrals for shelter, legal assistance, and counseling. Despite this, mental health consultation was documented in only 4 percent of 52 cases, social work referral was obtained in only 8 percent, and shelter information or other referrals were offered in only 2 percent, due in part to a lack of knowledge about referral resources and how to access them (Warshaw, 1989).

Receiving continuing education on intimate partner violence has been associated with increased screening for abuse (Carbonell et al., 1995; Chamberlain and Perham-Hester, 2000). However, other studies have shown this association to not be significant after adjustment for other factors (Rodriguez et al., 1999; Chamberlain and Perham-Hester, 2000). Evaluations of multifaceted domestic violence in-

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