Med School Research finds differences between urban, rural reports of violence

PIERRE -- A survey filled out by patients at 22 medical clinics in South Dakota has found that most victims of home violence and threats do not tell their doctors.

The University of South Dakota School of Medicine research was done under the supervision of Dr. Elizabeth Dimitrievich, an associate professor who practices obstetrics and gynecology in Sioux Falls.

Doctors should be among those on the front lines to detect and help prevent domestic violence, Dimitrievich said. A simple question from a trusted doctor could be all it takes to ward off injuries or save a life, she said.

''Perhaps in the past we haven't paid a lot of attention to training people to understand that this is a medical problem,'' Dimitrievich said. ''It's not just a personal or marital problem because it affects a person's health and well-being.''

Survey results, reported in the South Dakota Journal of Medicine, show that 10 percent of patients reported being physically assaulted by current or former intimate partners, 4 percent said they were threatened with assault, 28 percent said they were afraid of being assaulted, and 4 percent were forced to have sex.

Dimitrievich said 534 confidential surveys were filled out in October 2000. Patients were told not to put their names on the questionnaires, which were placed in sealed envelopes for collection and comparison. Those answering the surveys ranged in age from 15 to 96.

When patients who admitted being victims of domestic violence were asked if they had ever talked about it with a doctor, only 21 percent said yes. Most of them indicated uneasiness in bringing up the subject while others didn't think doctors would care or could help, Dimitrievich said

Many also said they were ashamed or fearful of telling their doctors about assaults or threats. Some worried their tormentors would find out, making things even worse.

''This is an intimate personal problem,'' Dimitrievich said. ''Because patients are probably uncomfortable with it, they may project their discomfort and assume that the physician is also uncomfortable. And maybe they've hinted, and the physician is uncomfortable or hasn't picked up on the hints.''

While 16 percent of those answering the survey in larger towns reported physical assaults, just 3 percent did likewise in rural areas. Similar rural versus urban differences were reported in the categories of threatened assaults, fear of assaults and being forced into sex.

Dimitrievich said she could not explain the disparities, but added that it is unlikely domestic violence is less prevalent in rural areas of South Dakota. People in smaller towns may be more hesitant to tell about it for fear of repercussions, she said.

Janice Davies, executive director of the Family Crisis Center in Redfield, confirmed that women in rural areas worry more about reporting domestic abuse because word travels fast in small communities.

''It's lack of anonymity,'' Davies said. ''If somebody reports it, it affects not only them but their families, and gossip spreads. Everybody knows.''

The South Dakota Coalition Against Domestic Abuse and Sexual Assault reported that family shelters and crisis centers served 14,584 victims in the year ending last Sept. 30.

One of those to help with the USD study, Dr. Maryam Mahmoodian, who is in her first year of family practice residency in Kansas City, said she was shocked by her first experience with a patient who was beaten by a boyfriend.

The woman was brought to a clinic by a shelter worker in a small South Dakota town, Mahmoodian said.

''I stood by helplessly watching, appalled at how anyone could do such a horrible thing to another human,'' she said.

When first learning to get patients' medical histories, Mahmoodian said she was not taught how to bring up the subject of domestic violence. Only one of the doctors who supervised her as a medical student ever mentioned the importance of asking about home violence, she said.

''I know that as a physician, if I don't ask my patients about domestic violence, the majority of them will never, ever bring up the subject,'' Mahmoodian added.

''Most of the information that I learned about local resources and counseling services for domestic violence victims, I had to seek out on my own and did not learn from experience or in medical school,'' she said.

''It scares me that I might not know what my patients are going through at home ... unless I ask.''

Dimitrievich said USD medical students are currently taught to ask about domestic violence in the same manner as they would inquire about any other health problems.

''They are mandated to ask every patient screening questions about domestic violence, and by doing that they are going to develop a routine,'' she said.

''Our personal bias or discomfort has to be broken down. We have to learn how to deal with this the way we deal with any other major health issue,'' Dimitrievich said. ''If we don't ask, we very rarely find out until it's too late.''

Davies, the shelter director at Redfield, said doctors must take a more active role in identifying domestic abuse and referring the victims to those who can help them.

This is an Associated Press Story

Rural Womyn Zone > Violence Against Rural Women

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