Some of the barriers that prevent physicians from screening include: fear of offending the patient; lack of knowledge, training, time and resources; sense of inefficacy; loss of the patient-provider relationship; personal experience with partner abuse. Sugg and Innui (1992) reported that 61% of practicing primary care physicians in their study did not receive education about domestic violence, either during medical school, residency, or continuing education. Similarly, a study by Parsons et al (1995) found that 71% of obstetrician/gynecologists reported lack of training as a major barrier to screening.
During the initial phase of our interdisciplinary peer-training model, we realized that physicians not only need this education, but also need to be involved in the training process. Therefore, attending physicians were included in peer training groups and now instruct other physicians. Physicians in our hospital attend an annual Grand Rounds on domestic violence awareness, screening, and intervention. Feedback has indicated that this is highly anticipated and well-received interactive presentation. In an attempt to reach physicians even before they begin independent clinical practice, the curriculum for the Obstetrics/Gynecology residents now includes an annual two-hour, interactive session. Physician response has been overwhelmingly positive.
It is clear that most physicians are not adequately trained in domestic violence screening and intervention during their medical education. With our interdisciplinary program, we are attempting to overcome some of the identified barriers to providing comprehensive care for patients.