Physicians Urged to Check for Domestic Abuse : Health: New AMA guidelines cite rise in violence by spouses. Doctors are advised to routinely ask female patients if they are victims.

Domestic violence against women has become so prevalent that physicians should routinely question their female patients about whether they have been abused, according to new guidelines issued by the American Medical Assn. on Tuesday.

The announcement coincided with publication of a series of studies on domestic violence in the current issue of the Journal of the American Medical Assn., documenting a widespread increase in abuse of women by their partners.

About one in four women will be attacked by their partners at some point in their lives, and more than 4 million women in the United States are severely assaulted by their husbands or boyfriends during an average 12-month period, one of the JAMA studies reported.

Moreover, one in three women who enters an emergency room has been abused, and 23% of pregnant women seeking prenatal care have experienced domestic violence of some sort, according to M. Roy Schwarz, AMA senior vice president for medical education and science.

Although domestic violence has been a professional concern for decades, the new guidelines, which embody the association’s recommendations but are not binding on physicians, represent the first nationwide attempt to address the problem. “After 20 years, we decided it was getting worse and not better. We had to do something about it,” Schwarz said.

“These guidelines are the state of the art about what every doctor should know about domestic violence,” Schwarz said, and explain “how you should deal with it.” The AMA also released guidelines Tuesday on detecting and treating child sexual and physical abuse as well as child neglect.

One of the biggest obstacles to dealing with domestic violence in the past has stemmed from physicians’ reluctance to address the problem with patients because of feelings of helplessness or fears of “opening a Pandora’s box,” said Nancy K. Sugg, a clinical assistant professor of medicine at the University of Washington, who co-authored a study in this week’s JAMA on primary care physicians’ response to domestic violence.

The new guidelines advise doctors to question women patients routinely about domestic violence. Physicians should ask female patients whether their partners have ever physically attacked them or threatened to, forced them to have sex or restricted their freedom of movement.

When a woman patient admits she has been battered, the physician should discuss her safety before she leaves the office and offer her written information on legal options, counseling, shelters, crisis intervention programs and community services.