R = Routinely Screen Female Patients 
Although many women who are victims of domestic violence will not volunteer any information, they will discuss it if asked simple, direct questions in a non-judgmental way and in a confidential setting. Interview the patient alone.

A = Ask Direct Questions

• “Because violence is so common in many women’s lives, I’ve begun to ask about it routinely:”
• “Are you in a relationship in which you have been physically hurt or threatened? If no, “Have you ever been?”
• “Have you ever been hit, kicked or punched by your partner?”
• “Do you feel safe at home?” “Does your partner try to control where you go or what you do?” “I notice you have a number of bruises; did someone do this to you?”
• If patient answers yes, see other side for responses and continue with the following steps.

D = Document Your Findings
Record a description of the abuse as she has described it to you. Use statements such as “the patient states she was…” If she gives the specific name of the assailant, use it in your record. “She says her boyfriend John Smith struck her…” Record all pertinent physical findings. Use a body map to supplement the written record. Offer to photograph injuries. When serious injury or sexual abuse is detected, preserve all physical evidence. Document an opinion if the injuries were inconsistent with the patient’s explanation.

A = Assess Patient Safety 
Before she leaves the medical setting, find out if she is afraid to go home. Has there been an increase in frequency or severity of violence? Have there been threats of homicide or suicide? Have there been threats to her children or pets? Is there a gun or other weapon present?

R = Review Options & Referrals 
If the patient is in imminent danger, find out if there is someone with whom she can stay. Does she need immediate access to a shelter? Offer her the opportunity of a private phone to make a call. If she does not need immediate assistance, offer information about hotlines and resources in the community (see other side). Remember that it may be dangerous for the woman to have these in her possession. Do not insist that she take them. Make a follow-up appointment to see her.

If the Patient Answers Yes:
Encourage her to talk about it.
“Would you like to talk about what has happened to you? “How do you feel about it?” “What would you like to do about this?”

Listen non-judgmentally.
This serves both to begin the healing process for the woman and to give you an idea of what kind of referrals she may need.

Validate her experience.
“You are not alone.” “No one has to live with violence.” “You do not deserve to be treated this way.” “You are not to blame.” “What happened to you is a crime.” “Help is available to you.”

If the Patient Answers No, or Will Not Discuss the Topic:
Be aware of any of the following clinical signs that may indicate abuse: Injury to the head, neck, torso, breasts, abdomen or genitals; bilateral or multiple injuries; delay between onset of injury and seeking treatment; explanation by the patient which is inconsistent with the type of injury; any injury during pregnancy, especially to abdomen or breasts; prior history of trauma; chronic pain symptoms for which no etiology is apparent; psychological distress such as depression, suicidal ideation, anxiety, and/or sleep disorders; a partner who seems overly protective or who will not leave the woman’s side.

If any of these clinical signs are present, ask more specific questions. Make sure she is alone.
“I am worried about you. It looks as though someone may have hurt you. Can you tell me how it happened?” “Sometimes when people feel the way you do, it may be because they are being hurt at home. Is this happening to you?”

If the patient denies abuse, but you strongly suspect it, document your opinion, and let her know that there are resources available to her should she choose to pursue such options in the future. Make a follow-up appointment to see her.

Resources

• 215-386-7777 Women Against Abuse, 24 hr. Hotline and Shelter
• 215-686-7082 Women Against Abuse Legal Center
• 215-751-1111 Women in Transition, 24 hr. Hotline
• 215-739-9999 English 24 hr. Hotline/Lutheran Settlement
• 215-235-9992 Espanol 24 hr. Hotline/Lutheran Settlement
• 215-763-8870 Congreso de Latinos Unidos
• 215-886-8725 Korean Women’s Support
• 215-627-3922 SEWAA (for women from Pakistan, Nepal, Sri Lanka and India)

©1995 Philadelphia Family Violence Working Group, c/o Physicians for Social Responsibility 215-765-8703. Adapted from NY Office for Prevention of Domestic Violence. RADAR action steps developed by the Massachusetts Medical Society. ©1992 Mass Medical Society. Used with permission.