Fixing broken bones and broken homes: domestic violence as a patient safety issue

Domestic violence (DV) is a significant problem in terms of both patient harm and cost. To better address this problem, the diagnosis and treatment of DV are considered within the emerging model of patient safety and medical error reduction. The case of a female patient who presents in the clinical setting following an incident of DV shows how medical errors can be analyzed as they are in medical cases not involving DV, such as when a person with abdominal pain is sent away from the emergency department with instructions to take an acid reducer and later suffers a burst appendix.

A number of factors inhibit the correct diagnosis and treatment of DV victims seeking additional treatment. Physicians often fail to screen for DV, misidentify symptoms, or deny the possibility of underlying DV, and patients often hide the symptoms and refuse to admit the problem. However, human factor errors related to knowledge, cultural norms, and individual biases; organizational factors, including lack of training and reimbursement; and technology factors related to information accessibility appear to play significant roles.

Failure to diagnose or adequately address DV can be interpreted as medical errors. Addressing DV requires a systemic response, which might begin with integrating education and training about DV into the clinical setting, ensuring the use of existing screening tools, and providing adequate and appropriate reimbursement levels.