Domestic violence takes a toll on our society.
Put aside the obvious costs to the victim and the legal costs of prosecution.
Our medical system also pays the price for Domestic violence.
The Centers for Disease Control estimates the nation spent nearly 4.1 billion dollars in 2003 for medical and mental health services related to domestic abuse.
One strategy for cutting those costs, and perhaps reduce further risk, is to screen patients for domestic violence.
But despite a state-wide campaign to increase screening in recent years, many providers still don't.
Hoping to light a fire under those physicians, emergency rooms, and clinics, the state's largest health insurer-Anthem- has produced an instructional guide to help address the issue.
New Hampshire Public Radio's Dan Gorenstein has this report.
For four years doctors and nurses in the Dartmouth-Hitchcock Emergency Room have been asking patients two simple questions:
Have you been hit, kicked or punched by a family member or intimate partner?
Do you feel safe in your house?
Registered Nurse June Stacy says initially, patients chafed or were even downright offended by the questions.
But she says over time, attitudes have begun to change.
T.5
:00 ... very rarely do you get anybody that is shocked when you ask that question, these are routine questions we ask everyone. And then you ask them if they feel safe and they answer in whatever way they do, I haven't gotten that shocked, or how dare you. It's been more, I think that's a really great idea that you are doing that, it doesn't apply to me, but I'm really glad you are doing that...this is a long time coming, those are the types of comments.
While patients may have grown accustomed to answering the questions, that doesn't mean it's easy for nurses and doctors.
Domestic violence screening forces health providers to face the awkward task of probing into someone's private family details.
And sometimes that's a very uncomfortable assignment.
But Anthem Medical Director John Robinson says commonly what prevents screenings is that doctors are afraid they might not get the easy answer.
And then they'll have to do something.
2:57 ... if a doctor doesn't feel comfortable in his connection with support services, he is going to be some what reluctant to bring up the issue at all for fear of opening Pandora's box and then not ebing able to provide any resources to the patient after having done that.
When that Pandora's Box is opened at Dartmouth Hitchcock, the staff knows exactly what to do: they immediately contact the local crisis center.
Dartmouth-Hitchcock, however, is not representative of all the health facilities in the state.
So to both help and push providers to recognize the costs of domestic violence, Anthem decided to publish a 30-page guide.
It came out last fall and provides doctors and nurses with state reporting requirements, screening tips and referral resources.
Anthem's John Robinson says the insurer wants providers to understand how pervasive the problem is.
7:26 ... a woman might present with a tension headache and the physician will go about prescribing medications, but will not get around to asking whether there might be some dv as a background for why this woman has a tension headache in the first place.
Anthem has begun to ask itself how much it costs when physicians and nurses don't ask those questions.
Coming up with that answer is difficult.
The AMA has estimated that 1 in 4 women is a victim of domestic violence during her lifetime.
But no one seems to know how many New Hampshire victims seek medical assistance every year.
Still, without those numbers, Anthem calculates that each year it pays at minimum $1 million dollars in medical claims due to domestic violence.
Jennifer Pierce-Weeks is registered nurse who works with the New Hampshire Coalition against Domestic and Sexual Violence.
She complains screening is still too inconsistent, and providers still don't understand how to do it properly.
But she says she has no illusions about how much ground has been gained in recent years.
Recalling a former patient, Pierce-Weeks remembers how it used to be.
T.9
3:42 the first time we saw her she had a black eye, and the second time we saw her, she had multiple injuries all over her, and the third time we saw her, she had a fractured clavicle, and the fourth time she had a head injury and was sexually assaulted, and all of that was at the hands of her abuser. It wasn't until her sexual assault and head injury she talked about the abuse. But we weren't asking either.
Pierce-Weeks, Anthem and others believe stories like those are becoming the exception.
And while the healthcare community broadly accepts screening is not a panacea, they say it's better than not asking at all.
For NHPR News, I'm DG.
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