Letters Intimate partner violence

Authors’ reply to Whitehouse and Fabre

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3943 (Published 18 June 2014) Cite this as: BMJ 2014;348:g3943
  1. Lorna J O’Doherty, honorary fellow1,
  2. Angela Taft, professor2,
  3. Kelsey Hegarty, professor1,
  4. Jean Ramsay, honorary senior research fellow3,
  5. Leslie L Davidson, professor4,
  6. Gene Feder, professor5
  1. 1Department of General Practice, University of Melbourne, Carlton, Vic, Australia
  2. 2Judith Lumley Centre, La Trobe University, Melbourne, Vic, Australia
  3. 3Centre for Primary Health Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, London, UK
  4. 4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
  5. 5Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. gene.feder{at}bristol.ac.uk

Unlike Whitehouse, we do not think that our findings will “discourage health professionals from identifying and signposting” as long as they receive regular and sustained training and resources on identification and appropriate responses.1 2 We are definitely not saying that clinicians should sit back and wait for disclosures of intimate partner violence.

We agree with Fabre that case finding or clinical inquiry triggered by a wide range of presenting symptoms or conditions is necessary, but would not use the term “screening” to describe that method of identification because of confusion with universal screening.3 We are also convinced by the evidence for the effectiveness of training and referral pathways for support to survivors of domestic violence.

The fact that US healthcare policy, including such distinguished organisations as the Institute of Medicine and US Preventive Task Force, recommends screening for intimate partner violence continues to surprise us in the absence of evidence for its effectiveness. This policy conflicts with the recent evidence based WHO guidelines.4 In addition, UK National Institute for Health and Care Excellence (NICE) guidelines and the Canadian Task Force on Preventive Health Care appraisal of the US guidance do not support universal screening.5 6

We believe that the imposition of screening in some countries and the debate over identifying survivors of domestic violence have distracted researchers and advocates from developing interventions after disclosure of such violence and system level changes in healthcare settings that may benefit abused women and their families.


Cite this as: BMJ 2014;348:g3943


  • Competing interests: GF chaired and KH was part of the guideline development group of the WHO responding to intimate partner violence and sexual violence against women guidelines; GF chaired the programme development group of the UK NICE domestic violence and abuse guidelines.

  • Full response at: www.bmj.com/content/348/bmj.g2913/rr/699511.


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