Citation

Warshaw C. Acad. Med. 1997; 72(1 Suppl): S26-37.

Affiliation

Behavioral Science, Primary Care Internal Medicine Residency Program, Cook County Hospital, Illinois, USA.

Copyright

(Copyright © 1997, Association of American Medical Colleges, Publisher Lippincott Williams and Wilkins)

DOI

unavailable

PMID

9008585

Abstract

Physicians' effectiveness with victims of domestic violence requires a model based on the principles of prevention, safety, empowerment, advocacy, accountability, and social change. The incorporation of these principles into clinical practice requires, in turn, a paradigm shift in the structure of medical education from biomedical models to a more comprehensive framework. Such a model would include recognition of the individual and societal forces that generate and sustain abuse, contextual factors that mediate women's experiences of abuse and shape their options, and individual and systemic factors that shape providers' responses. This perspective makes it easier to consider, for example, that psychiatric symptoms may actually be adaptive coping methods or survival strategies. Traditional medical teaching formats do not provide opportunities to address the attitudes and feelings that may affect a clinician's ability to provide appropriate care or to acquire the skills necessary for an optimal response. Role plays, faculty modeling, video and in-person observation, and simulated patients are useful tools for helping medical students learn to interact in ways that are not retraumatizing or disempowering to patients. Recognizing the potentially abusive aspects of medical training and creating environments that do not permit such behavior are important both to improving the health sector's response to domestic violence and creating a society that does not tolerate abuse. Informed by a broader perspective, medical students are less likely to accept the constraints of their practice environments and may join with others to bring about social change.

Language: en