National Domestic Violence Hotline Blog

Domestic Violence: Medical Records Can Sound an Early Warning

The following blog entry is written by Nancy Fliesler. It originally appeared on Thrive, Children’s Hospital Boston’s health and science blog. It is being featured on our blog with permission.

Domestic abuse often goes undiagnosed until too late — yet medical records often contain subtle clues that doctors often lack the time to fathom out. Now, researchers from the Children’s Hospital Informatics Program and Division of Emergency Medicine demonstrate that tapping commonly available electronic health records could help doctors spot abuse early. This display, designed for physicians, pulls a patient’s diagnostic history into one view, sounding an alert when the pattern of visits suggests possible domestic abuse.

Each colored bar above represents a diagnoses recorded in the patient’s chart, grouped by category, during the four years before her abuse diagnosis; the most recent diagnoses are shown at the bottom. The color coding denotes the degree of abuse risk, calculated using data from the study (green, low risk; yellow, medium risk; red, high risk). As indicated by the blue “detect” arrow, the system would have sounded an alert as early as 34 months before domestic abuse was actually diagnosed.

In the future, the researchers hope that their models can detect when a person is at risk for abuse before abuse even occurs. Although the study, published in the British Medical Journal, was done in adults, the plan is to validate the model in children, too, and to develop similar models for conditions that are often missed, like depression and early-stage diabetes. According to Ben Reis, PhD, who led the project, such “intelligent histories” are an important step toward the larger goal of predictive medicine — helping busy physicians not by making diagnoses for them, but by offering a decision support tool that can flag patients who merit specific screening.

5 replies
  1. SYLVIA says:


    • carol says:

      Dear Sylvia,
      I am A Over 45 Yr Old Woman Who Has Been Abused In Every Way I Can Think Of.It Started When I Was A Baby.I Was Told By My Very Abused Mother Whom Died At The Early Age Of 45 By The Hands Of The Man She Married 1 Yr After My Birth.I Was Told She Married Him Because If At That Time If A Man Had more Than One Child He Would Not Have To Go To War (she Was Pregnant With My Half Sister At The Time And The Timing Would Be Perfect To Keep Him Out)He Was Smooth,Said He Use To Play The Guitar And Look Like Elvis Presley.She Was A Waitress And Thats How They Met.Till This Day I Have No Idea Who My Real Father Is.So My Fist Told Abuse Story Told To Me Was That She Was At Work And He Was Watching Me But Had A Poker Game Going On And To Quiet Me Up He Put Slow Gin In My Bottle And My Mother Came Home To Me Pulling My Hair Out And Screaming,Crying And The Like.She Thaugt I Was Sick But He Told Her What He Had Done And Thaught It Was Funny,So My Mother Had Been Kick Out Of Her Abusive Family Home Now Stuck With 2 Children By 2 Different Fathers Which Was A Big No No To Her Father And Since I Was Born Out Of Wedlock She Was Not To Go Home She Was The Black Sheep Of A large Catholic Family And He Was Hiding Her Out Because I Was To Be Sold Or Killed According To The Nationality Of Her Family.So He Protected Me By Moving Us To Alabama ,I Can Still Recall A Small Part Of The Train Trip.So Now Hes Really Got Her With His Family.I Can Recall Hiding In A Corner Because I Wet My Self And According To Her A Child Was To Be Potty Trained By The Age Of 1.Needless To Say I Got It And Got It Good With The Switch.She Was So Abusive Towards Me And I Can Only Think It Was Because I Was Not His.He Never Spanked Me Or My 2 Sisters Or Brother,My Mother Was The The Punisher.,She Moved Up To His Leather Belt And When You Got It You Were Not Allowed To Move Or Cry Or Scream Or You Would Get It Worse.She Said I Braught You Into This World And I Can Take You Out.So I Learned Very Young On How To Take It And Hide It Because If You Told She Said She Would Kill You,So At The Age Of 7 We Moved To Detroit Close To Where She Was Raised.Went To A Catholic School And Went To School With Belt Welts And Never Told.The Abuse Changed As We Got Older,But When I Became About 10 I Saw What He Was Doing To Her It Got So Bad That He Smashed Her Head Thew A half Glass Door While She Was Trying To Get Upstairs. I Took A Piece Of Glass Because I Was Trying To Help Her And He knock Me To The Ground Where the Glass Was And Cut My Face And Ran Upstairs Bleeding To Try To Get The Focus On Me To Stop Him From Hurting Her Anymore,Well It Did Stop The Fight But He Said He Didnt Do It So I Thought I Was Going To Get It But She Didnt Believe Him And now They Were Probably Wondering How They Were Going To Explain That..So Much Abuse Happpened I Could Write A Book And Thats Just On My Childhood.They Made Everything Look So Normal To The Outside That When I Told My Highschool Friends When I Had Reached About 20 That They Said They Thaught My Mother And Father Were The Nicest People And Could Hardly Believe My Stories Of What Happened But We Were Never Allowed To Have Anyone Spend The Night,We Were Able To Spend The Night At Our Friends House Though..My Mother Or Father Never Huged Us Or Kissed Us,I Suffered From nightmares and would go to her and lightly Tap Her Saying Mumma,Mumma.She Would Awake And Slap Me And Tell Me To Go Back To Bed,But I Couldn;t Because My Room Walls Would Be Breathing And I Thaught I Would Die If I Went Back In The Bedroom Where My 2 sisters And i Slept In A Bunkbed With A Trumble That I Slept On The Pulled Out From Under The Bed In The 10 by 10 Room.I Was Very Closetifobic And Still Am.I Use To Get Terrible Periods That Started When I Was 12;My Flow Was So Heavy That I Would Pass Out Allot But Got In Trouble For That Too,She Said I Was making myself passout;I Would Get Frequent Nosebleeds And She Would Make Me Lay Flat On The Floor And Swallow My Blood Till It Stopped,,I Would Get Terrible earaches and swalowen tonsils That I Could hardly talk.Finally She Took Us To The Doctors To Get Immunised With That Gun looking thing with lots of needles after standing in a very long line,And Then She Had Gotten A Family Doctor.I Never New What Was Wrong With Her Then But I Do Now.One Visit i Had Gotten A Shot And Recall Standing Next To Her Waiting To Check Out And as I Was Looking At The Clock It Started Getting Blurry And I Was So Scared I Was Going To Pass out,I Tried So Hard Not To But I Did And As I Was Starting To Come To I Could Hear My Mother Yelling At The Nurse Because She Was Holding My Legs Up To Get Blood To My Head Or Something To Help Me Come To.She Was So Mad At Me And Told The Nurse To Let My Legs Down That I Did It All The Time For Attention.The Nurse Told Her That allot Of Kids Pass Out After That Shot But She stood her ground.Well Come To Find Out By About The Age Of 15 i Had Had A DNC And Found Out I Had my early 20s i had to have pinch biopsy for cervical cancer because of a grade 3 pap.pre cancer cells,had to have laser surgery.Oh Forgot Had Tonsil Out At !2 Also.But This Is A Long Story Short.Maybe I Will Right A Book.But After That I Found Myself Pregnant At The Age Of 16 Almost 17 .You See My Mother Told Me That If A Boy Kisses you and puts his toung in your mouth you would get pregnant and never told me anything else,nothing about intercorse so a boy that was 4 yrs older than i who had the nicest car in the neighborhood got ahold of me and one day took me to the basement he lived in and well that was my first time and i remember saying cant i get pregnant like this and he said no,i know what i;m doing.i cried the whole time .needless to say i got pregnant the first time i did it.So I Got Kicked Out,I Tried To Hide It As Long as Long As I Could But She Found Out And Said You Take Your Clouse And Get Out You Go With What You Came With,Nothing,and You Leave With Nothing Not Even A Pillow Or Blanket.So I Left With 2 Garbage Bags Walking Down The Street Crying Tryng To Find Him.I Found Him And Moved Into The Cold Basement With Him,It Was Winter So I Was Able To Keep Things Cold Outside Under The Porch .Had One Skillet That Was Electric To Cook My Golosh Speggetti,Hot Dogs And Such In.Had To Wash The Dishes In The Washmachine Tube,Had To Take A Shower In The Mid Of Basement From Shower Head In Cieling But No Room Just Out In The Open Same As Toilet ,If I Cooked Wrong,Complained About How Cold It Was That I Needed A Bed Instead Of The Old Love seat That I Was Alone All The Time If I Wouldnt Feel Like Having Intercorse Fold His Close Wrong,You Get The Idea I Would Get It, He Stole The Only Thing I Had Of any Value Was My Mother 2 Sets Of Old Wedding Rings She Gave Me When I Was Young.I Think They Were Past Down To The Eldest Girl.I Had nothing.And New How To Take Abuse,After My Son Was Born He Moved Us Up Stairs To A Small Appartment.Well That When It Got Worse,He Would Drag Me Threw The House Infront Of His Friend Laughing.Kick Me To Pulp While Curled Up In The Corner,so many things.well finnally after another move I Got A Job And Started Saving Money On The Side.He Expected Me To Give Him All My Money But I Saved Half My Tips,Sometimes Lied And Said It Was Really Slow So I Saved Up Enough Money To Get My Own Apartment And Funiture And A Car.And One Day While He Was Gone I Took My Son And Moved,He Found Us And Would Scream For Me,Climb Up To My Secound Story Apartment And Try To Break in,Kick In My Door But The Police Said He Didnt Do Enough Damage To Take Him To Jail,Paid 500.00 dollors to Have Him Served With A Restaining Order But Was Told They Couldnt Find Him And My Money Had Run Out For The Server.Which I Think I Got taken For A Ride By That Attorney .So When I called The Police The Would ask If It Was His Son And if We Ever Lived Together and Would Do Nothing Because it Was His Son And I Didnt Have A Bruse.Well Abusers Now Where And How To Hit You So As Not To Show,He Pulled A Shotgun Out And Raped me But Nothing Was Done,I Called The Police To Much They Wouldnt Show Up Till He was Long Gone And Then Tell Me They Couldnt Do anything To Him Unless I Had Proof Or A Witness.My Witness Was My Son Who Is Now 28 And Just As Big An Alcoholic And Just As Abusive As His Father,Always Bar Fights And The Police are After Him For Stabing An Officer In The Foot While In Chase He Got away Just As Slick As His Father And Mean As Heck To Me.It Makes Me Sick That I Raised This Child And He Treats Me Like He Does You See He Bonded With My Even More Abusive Husband Abusive In Every Way,I Only Thaugh I Knew Abuse .NO Now I Know And After 20 yrs Staying With This Man Because I Wanted My Other 2 Children By Him To Have A Stable Life The Reason I Was So Eager To Get Married in The First Place For My Eldest,You Think Your Doing The Right Thing By Staying With This Kind Of Person Because All You Want Is To Break The Cycle And Never Spank Them Or Hurt Them In Any Way.Hug Them Kiss Them Show Them All Your Love Give Them The Childhood You Wish You Had{ Everything}Well I Over Did Somethings But These Two Show Me So Much Love But The Abuse I Thaught I Was Hiding They New All About.Children Are Smart.They Here Things You Think They Dont.So Finally Im Divorcing Him But He Is Making It So Hard.He Hasnt Paid Child Support Since I Filed.Stoped Paying All The Bills Except The Morgage,And Guess What Im Disabled.So All I Get Is A Small 638 Check A Month And 38 For 2 Children.He Will Not Spend Anytime With The Kids Nor Give Them Money,But Does Pay Cell phone For Them Because Hes A Hacker ,,,Long Story But I Cant Do anything Without Him Knowing,He Use To Have Cameras All Over The House Keylogger On My Pc Stoll My Email adderess And Acted Like He Was Me.So Much More.So In Short,Along Short Do Whatever You can To Keep Your Daughter Safe.The More You Show You Dont Like Her Boyfriend The More She Will Want To Go Againest Your Wishes If Shes Young .Recall When We Were Young Most Of The Girls Wanted The Cool Guy.The One Thats Name Was Known By Many,That If You Were With Him He Would Protect You.Just Put Your Feet In Her Shoes look Threw Her Eyes What Has She Seen That You Didnt Think She Did.Please Try To Get As Close To Her As You Can.So If What You Think Is True And If You Think It It Is Probably True.Make Sure She Knows That When And If She Knows She Has Her Momj To Protect Her’We Can Save So Many Children By Showing Them That At Least One Parent Loves Them And Will Do Anything To Keep Them Safe;She Will Come To You And Tell You If You Make That Door Well Known To Be Her Saftey Net Involve Your Family Rebuild Bridges So If She Doesnt Come To You She Will Go To One Of Them.Yes I Left Out So Much But Im Not Well But I Care So Much About Children;She Will Always Be Your Baby In Your Eyes Let Her Know That And Feel That Safety..Blessings

    • tara says:

      hi my name is tara. im 17 years old and i was in a very violent realonship. My mom knew first. please get her out of the house as soon as you can. Be there for her beacuse she will come to you just listen dont get all mad it dont help at all. Good luck i wish you and your daughter alot of luck!

  2. Leilani says:

    I am a victim of domestic violence and a registered nurse. I want to urge all medical professionals to educate themselves about domestic violence and to screen ALL patients for any/all abuse. Even though I was a fellow healthcare professional, the healthcare providers for my care FAILED to assist me in getting out of an abusive situation. How? Failure to document the injuries sustained and failure to screen me for abuse. With the today’s legal system, documentation is needed to prove abuse. Document only the facts: type of injury, statements the victim says about the injury. Most of the time the reason for the injury doesn’t make sense. But the exact quote can prove that the victim is in fear of her life. (I do want to state that victims can also be male but for simplification of this comment, I will continue to use “her/she”) Lastly, because we healthcare professionals are also educators of the public, please, educate those that can greatly influence the victims in seeking safety from their abusers: clergy persons, law enforcement, fire rescue, teachers, etc. Break the silence, Talk about domestic violence/intimate partner violence/dating violence! Encourage everyone to love!! Don’t turn away from the abusers who are open and blatant with their abuse. Tell them their behavior is unacceptable and that we are all watching!!! Get them help!

  3. Taira says:

    I think my Younger sisiter is in a Violent relationship. I am not sure what to do. I am afraid thet if I confront her she will push me away. The worse papt is that she just had a Baby 3 months ago. When they are arguing over the phone I ask her to stay at my house until the quit agrueing and she will get upset with me sand say he has to see his son. Please if anyone can reach out and help me with advise I would appriciate anything.

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