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June 17, 1992

Primary Care Physicians' Response to Domestic Violence: Opening Pandora's Box

Author Affiliations

From the Division of General Internal Medicine, University of Washington, Seattle. Dr Sugg was a fellow in the Robert Wood Johnson Clinical Scholars Program, Seattle, when this work was completed.

JAMA. 1992;267(23):3157-3160. doi:10.1001/jama.1992.03480230049026

Objective.  —To explore primary care physicians' experiences with domestic violence victims to determine the barriers to problem recognition and intervention in the primary care setting.

Design.  —Ethnography, a qualitative research method involving the use of open-ended, semistructured interviews.

Setting.  —An urban health maintenance organization serving a predominantly white, middle-income population.

Participants.  —Thirty-eight physicians, predominantly family practitioners (89%), were interviewed.

Results.  —Analysis of the interviews revealed that physicians found exploring domestic violence in the clinical setting analogous to "opening Pandora's box." Their issues include lack of comfort, fear of offending, powerlessness, loss of control, and time constraints.

Conclusion.  —This study revealed several barriers that physicians perceived as preventing them from comfortably intervening with domestic violence victims. These issues need to be addressed in training programs. Further studies should be done to assess generalizability of these findings to other groups of physicians.(JAMA. 1992;267:3157-3160)