Domestic violence is a social, business and health priority

A woman comes to the doctor with depression, fatigue and insomnia. A co-worker stays late in the office even when there is not much to do. A sales associate appears tired and distracted.

For each of these individuals, domestic violence — physical, sexual, verbal, emotional or psychological abuse against an intimate partner — could be the underlying cause of distress. Historically, domestic violence has been viewed as a criminal issue — according to police records, almost 1 in 3 female homicide victims are killed by an intimate partner.

But today we know it as a social, business and health priority, as well. Not only does it cause personal suffering, but domestic violence also reduces productivity, leads to absenteeism and drives up health care costs. And unless people are trained to look for it and ask about it, domestic violence is rarely identified.

The statistics are staggering

Domestic violence is all around us. It affects our families, our friends, our coworkers and our neighbors. Most of the time, we are not aware it’s happening.

In the U.S., 24 percent of adult women and 14 percent of adult men have been physically assaulted by a partner at some point in their lives. It is the most common cause of injury for women ages 18 to 44. And it leads to an increased incidence of chronic disease: Abused women are 70 percent more likely to have heart disease, 80 percent more likely to experience a stroke and 60 percent more likely to develop asthma.

Nearly a quarter of employed women report that domestic violence has affected their work performance at some point in their lives. Each year, an estimated 8 million days of paid work is lost in the U.S. because of domestic violence.

Domestic violence costs $8.3 billion in expenses annually: a combination of higher medical costs ($5.8 billion) and lost productivity ($2.5 billion).

Addressing this issue could save thousands of lives and billions of dollars. But as long as the symptoms and consequences of domestic violence go unnoticed or overlooked, nothing changes.

Addressing domestic violence starts with raising awareness

A growing number of health care professionals and business leaders understand the importance of recognizing and addressing domestic violence. But they remain in the minority. Most doctors don’t take the time to learn about and use established screening techniques. And unless domestic violence can be identified, we can’t help victims deal with the abuse or reduce the long-term consequences.

Some businesses have taken action and seen results. Companies like Verizon, Allstate, Prudential, Avon, Mary Kay, Macy’s and Home Depot have trained their employee assistance teams to screen for domestic violence. They’ve provided necessary information to their staffs and, most importantly, they’ve seen the rate of identification increase significantly.

Several years ago, I had the chance to speak at a conference on domestic violence hosted by Liz Claiborne, now Fifth & Pacific Companies. The meeting was well attended by executives from across the industry. As part of the program’s goal to raise awareness, we heard from the victims about their experiences. Their heart wrenching tales of fear and abuse reinforced this nation’s need for early intervention.

We’ve seen some progress since then, but the silence remains deafening.

Everyone has a role in curbing domestic violence

While there are significant differences in the roles that colleagues, health care professionals and friends can play, the secret nature of domestic violence requires vigilance from everyone.

The role of the employer. Employed individuals spend the majority of their waking hours at work. That’s why employers are ideally suited to spot the symptoms of domestic violence and intervene. In fact, providing resources and support is part of a company’s requirement for ensuring a safe work environment.

Senior executives can promote a culture that includes domestic violence awareness and prevention. Information about domestic violence should be shared at every employee orientation. It should be addressed at every occupational health visit. It can be incorporated into workplace wellness activities. When the issues of domestic violence are brought front and center in as many venues as possible, we have a better chance of breaking the silence.

Employee assistance counselors and human resource professionals need to be ready to respond to inquiries, refer victims to advocacy services, engage with law enforcement when appropriate and offer security assistance when necessary.

Managers need to understand that domestic violence may explain absenteeism and ongoing health problems. They should be trained to recognize potential signs of domestic violence, including signs of depression and evidence of physical harm. They should be trained to ask about it with confidence and without judgment. They should know where to refer individuals who are victims of domestic violence, including employee assistance programs (EAP) and community resources.

Without a stable job, most victims are unable to remove themselves from a dangerous domestic arrangement and escape the long-term consequences of abuse.

The role of the clinical team. The Affordable Care Act identifies domestic violence screening as a national health priority, alongside smoking cessation, exercise, nutrition, substance abuse reduction and the provision of mental health services.

Health care professionals play an important role in identifying victims of domestic violence. When women talk with their physicians about domestic violence, they are four times more likely to receive the needed services and end the abusive relationship.

Physicians need to pay attention to physical and behavioral signs of potential abuse. They should ask about domestic violence as a potential cause of unrecognized medical problems. They need to be trained to communicate in ways that are supportive and non-judgmental. And when patients ask for help, they should be aware of the available community and national resources.

The role of family, friends and colleagues. Family members, friends and colleagues are often the first to hear that someone they know is a victim of domestic violence. When people are educated about the frequency of domestic violence, they are more comfortable talking with others. Being able to offer support can mean the difference between life and death. A simple statement like “I’m sorry this is happening to you” is a start. Offering to help the victim obtain assistance – whether through the national domestic violence hotline, a company EAP or a local domestic violence advocacy organization – is a crucial next step.

Putting an end to domestic violence has broad implications

Regardless of who helps identify the problem or which agency provides the care, the majority of individuals who end violent relationships do not experience another one. The victims of domestic violence are just that: victims. They don’t want to be in abusive situations. They just are. And we all need to recognize the role we can play in helping them.

When we fail to provide the training and infrastructure needed to address domestic violence, the individual suffers. But so do the individual’s children, business colleagues and all of us. As we search for ways to improve this country’s health while lowering costs, shedding light on domestic violence and protecting the victims of abuse is a great place to start.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on


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  • DoubtfulGuest

    I agree NormRx, it’s a human problem, not a gendered one, and we’ll get much further as a society toward stopping it when we recognize that.

  • DoubtfulGuest

    So…I reported a history of abuse, (I left that situation some time ago) to previous doctors for reasons that I thought might be medically relevant. This was used as the basis for accusing me of malingering when I still didn’t have a diagnosis for my symptoms. There was no actual evidence of deceit on my part. I’m curious how that’s supposed to work? I’ve read a lot of papers on it and the logic still escapes me. I turned out to have a pretty serious progressive disease instead.

    Oddly, one doctor out of the whole bunch responded normally, as you describe, Dr. Pearl. She said she was sorry to hear it, asked if I was safe in my current situation (yes) and gave me the contact information for the domestic violence shelter, just in case I ever needed it. Great! I wish she could train these other people to handle it like she did.

    • querywoman

      It’s easier to bandaid domestic violence injuries and give victims tranquilizers and antidepressants than it is to give them financial assistance and social services to help them get away.
      There aren’t enough domestic violence shelters, but a lot of victims won’t go to them.

  • DoubtfulGuest

    Also, this falls into the funny/not funny category, but at my current hospital they do screen at every visit. It makes me wonder how the doctors there respond when someone says “yes”. It’s no longer an issue for me so I’m not going to try to find out. But the nurse, who is truly a sweetheart, asks “Any domestic violence?” and sometimes even “How’s the” (domestic violence) even when you’ve said there isn’t any, and she uses the same chirpy tone of voice that one would use to ask “Do you want fries with that?” Awkward…

    • querywoman

      I wrote of having to do this very thing before I left public welfare. We had to make referrals.

      • DoubtfulGuest

        She’s a great nurse, I like her a lot. I think she gets to working hard and goes on auto-pilot. Plus, it can’t be easy to ask that question.

  • querywoman

    Statistics are just speculative, anyway. The Sewells says lesbian relationships are the most violent of relationships.
    Men usually punch, hit with the power of their arms and fists, but occasionally kick each other in the you-know-where, between the legs.
    Women do more than hit; they pull hair, bite, scratch, etc.

  • querywoman

    Before I stopped working in public welfare in 2001, we had to ask clients if they needed domestic violence referrals, and that included asking men and couples who seemed to be happy with each other.
    Recently, Houston ER doctor, Dr. Angela Siler-Fisher broke into the home of an alleged rival, Dr. Marcelle Mallery, and did some criminal mischief.
    A lot of people have sympathized with Dr. Siler-Fisher. What if a man had broke into a romantic rival’s home?

  • querywoman

    The same law that required me to ask clients about domestic violence before I left public welfare is probably what applies to emergency room personnel now.
    I don’t recall anyone asking me about it when I had serious pneumonia last year and did 8 days in the hospital.

  • DoubtfulGuest

    I’m actually a closet cynic (Shh…don’t tell anyone). Reactive behaviors? What do you think the causes are? Do we really know? People turning a blind eye to it sure seems to help it fester.

    • safetygoal

      I think a good percentage of violent reactions from either sex are fueled by drugs and/or alcohol.

      • DoubtfulGuest

        Often a contributing factor, to be sure, although I don’t know that we can say it’s an underlying cause. Also, I wonder how much violent behavior is really reactive. Reactive to what? It’s that old “nature vs. nurture” question.

        I’ll take “brain worms” for 200.

  • Suzi Q 38

    Sad that the police in the situations you describe did not do anything.