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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.

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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.