Confidentiality

Critical to any health care response is confidentiality. Inappropriate disclosure of information concerning domestic abuse may endanger or victimize patients further. Battered women may fear retaliation and are in the best position to determine when it is safe for them to leave. Health care providers, like advocates, must ensure that women know that the information they share will be kept safe.

Although documentation of the abuse is important, any policy regarding documentation should be accompanied by protocols that ensure that this information is kept confidential. In developing the protocol, it is important to assess who currently accesses or has opportunities to access patient medical information. The protocol should define who should have access to what patient information, under what conditions they may have access to this information, when patients should be able to limit further dissemination of their medical information, and when spouses may have access to patient information.

Confidentiality concerns may require changes to the way in which the hospital or other care facility communicates with the patient. Each patient should be given the option to communicate by alternative means or locations, such as directing correspondence to an alternate address or communicating only by mail.

The FVPF's Health Privacy Principles for Protecting Victims of Domestic Violence (2000), provides an excellent overview of the questions that should be asked in designing a privacy policy that adequately respects patients' autonomy and need for confidentiality while understanding that sharing of patient information is sometimes needed to ensure proper treatment. The Toolkit to End Violence Against Women, created by the National Advisory Council on Violence Against Women and the United States Department of Justice's Violence Against Women Office, offers a health care chapter, detailing additional strategies advocates can use to improve the health care system's response to domestic violence.

Support and Affirmation

Health care providers should avoid victim-blaming behavior that can reinforce a victim's isolation and undermine her self-confidence. Training health care workers on domestic violence issues, the health effects of domestic violence, and the ways in which health care providers can contribute to efforts to end domestic violence can be a highly effective advocacy strategy. Training can help sensitize doctors and counter prevailing myths about domestic violence. For example, doctors may be skeptical about the veracity of women's accounts of violence. According to research in Poland, for example, forensic doctors may consider it their duty to determine whether a woman's injuries were caused by an assault or were "self-inflicted." From MAHR, A Report on Domestic Violence in Poland 36 (2002).