Although there are certain clues to abuse, the presentations of battered women in the emergency department are so varied that the diagnosis may be missed if the physician fails to ask directly about the presence of violence in the patient's life. As discussed earlier, many battered women will respond truthfully if questioned, in private (not at the triage desk) and in a sensitive, nonjudgmental way. Screening may be verbal or by a written questionnaire. The American Medical Association 1 suggests asking the following questions:
• Are you in a relationship in which you have been physically hurt or threatened by your partner? Have you ever been in such a relationship?
• Are you (have you ever been) in a relationship in which you felt you were treated badly? In what ways?
• Has your partner ever destroyed things that you cared about?
• Has your partner ever threatened or abused your children?
• Has your partner ever forced you to have sex when you did not want to? Does he ever force you to engage in sex that makes you feel uncomfortable?
• We all fight at home. What happens when you and your partner fight or disagree?
It is sometimes helpful to use framing clauses when verbally inquiring about domestic violence. Examples of this type of questioning are as follows:
• Violence in the home is very common and can be very serious. Therefore, I routinely ask all of my patients whether they are experiencing domestic violence, because no one should have to live in fear and because there is help available.
• Whenever I see injuries of this type, it is often because someone hit them with a fist. Is that what happened to you?
• Many women experience some type of physical abuse in their lives. Has this ever happened to you?
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