Doctors and Abuse

An email follow-up question from the Review Of Systems post:

I don't understand why they ask, "Have you ever experienced physical/verbal abuse?" This doesn't have anything to do with establishing a diagnoses. What's the point?

Doctor D doesn't enjoy asking prying personal questions. It makes everyone uncomfortable, but this is a question that doctors should be asking more often.

Medical professionals do a terrible job identifying people in danger from family violence. Statistics show that people who seek more medical attention have higher rates of abuse than the general population. A study found 1 in 3 females who visit emergency rooms have been recently abused. Doctors usually just don't find out. We may do a great job protecting someone from Hypertension, while the biggest threat to their health is the person with whom they live. Doctor D knows he has missed opportunities to help patients in dangerous situations. Sometimes simply discussing abuse can be a step towards connecting to resources that save lives.

Because doctors do such a crappy job at this, we are frequently reminded to ask everyone about domestic violence. Doctor D must admit, he is still pitiful at broaching these questions. It makes people uncomfortable when doctors ask, and doctoring is already an uncomfortable job. You expect us to be friendly and trustworthy while asking about how much you really drink and sticking our fingers in your orifices. It makes for awkward interactions!

Asking such questions in a trusting doctor-patient relationship can be very useful, and usually a patient will understand the doctor has good motives. The reader who emailed Doctor D was asked on a paper questionnaire. Sounds like the doctor was trying to follow the recommendation to ask while avoiding the awkward conversation. Unfortunately it shifted all the awkwardness to the patient and also confused her. I also imagine the paper-based format won't uncover many cases of abuse, because patients may hesitate to disclose this on a form.

I think this reader's doctor had good motives, just an ineffective approach. Doctor D personally apologizes for doctors. We all do a lousy job at discussing these sensitive topics. It is harder than you think. Please be patient with our fumbling attempts at difficult questions.

A question for you:
What is the most uncomfortable question a doctor every asked you? How did you respond? You can comment here or e-mail Doctor D.