Spouse abuse. Care goes beyond the office door

Domestic violence is an underreported and underrecognized problem with immense medical, social, psychological, and emotional costs. Vigilance in recognizing the victim of spouse abuse and direct questioning of the patient about the possibility are the first steps in identification and treatment. Being alert to signs of abuse in the face of patient denial is also important. Treatment of the medical and surgical sequelae of abuse is just the initial stage of therapy. A concerned, knowledgeable team that can address the patient's individual psychological and emotional needs while providing a safe alternative living situation and referral resources is critical to success. Great caution should be used in prescribing psychotropic medication. Clear documentation of an abused patient's injuries serves both the victim and the physician well, but reporting the information to authorities should only be done when it is legally required or at the patient's request.