[Skip to Content]
[Skip to Content Landing]
Views 746
Citations 0
March 25, 2019

Unseen Trauma—Our Responsibility to Discover

Author Affiliations
  • 1Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2019;179(5):609. doi:10.1001/jamainternmed.2019.0234

She came to my primary care office because of splitting headaches and a bruised eye after a fall. Fifteen minutes into the history, she burst into tears. The inciting question: “Do you feel safe at home?” The patient was a survivor of physical violence from an intimate partner, a trauma that nearly 1 in 3 US women will experience during their lifetime.1 This patient had experienced frequent punches to her nose, eyes, and ears and had been seen by other clinicians, yet there was no mention of violence in her medical record. I comforted her, documented pictures of the wounds in my medical note, and, after verifying she had a safe place to stay, connected her with a domestic abuse intervention program. They helped her find a lawyer to file a restraining order.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    Unseen Trauma and the Bystander Effect
    Joel Brown, MD | University of Hawaii
    Dr. Foote describes the real difficulties physicians encounter when confronted with patients suffering from domestic abuse. He includes a description of the bystander effect—a term psychologists created after the infamous 1964 murder of Kitty Genovese in New York City during which 38 people failed to intervene to stop the attack. However, the 2007 article he cites by Manning and colleagues (1) casts serious doubt about the accuracy of the murder story, and does not support the validity of the “bystander effect.”


    1, Manning R, Levine M, Collins A. The Kitty Genovese murder and the social psychology of
    helping. Am Psychol. 2007;62(6):555-562.