How to Ask

Written questions
Oral questions
Asking indirectly
Framing the question – this sets the stage for asking, so that the patient doesn’t feel embarrassed that you singled her out to ask
Asking directly
SAFE questions – a series of sequential questions

Written questions

Written questions are more efficient for your time, but, realizing that many patients with abuse issues will check “no”, please always add:

“I see that you have checked “no” about questions relating to feeling safe with your partner. Do you have any other questions about this issue? (No.) I just want you to know that if anything like this ever does come up, this is a safe place to talk about it and get help.”

For written questions, you can use a combination of the questions under oral questions (the Agency for Healthcare Quality and Research suggests you ask at least three questions), or see Resources for a list of written screening instruments.

In addition, if you use written screening, always sign off on form, and/or document in your records the written screening results with a dictation comment or form checkbox, to insure that you do not overlook a “yes”.

Oral questions

Oral questions may be part of your routine history at new and annual visits, or may come up in response to a suspicious sign or symptom. Here are several options in each category from which to choose.

Asking indirectly

• How are things going at home?
• What about stress levels? How are things going at work? At home?
• How do you feel about the relationships in your life?
• How does your partner treat you?
• Are you having any problems with your partner?

Framing the question

• Because unfortunately violence is so common in our society, I have started asking all of my patients about it.
• Because domestic violence has so many effects on health, I now ask all my patients about it.
• From past experience with other patients, I’m concerned that some of your medical problems may be the result of someone hurting you. Is that happening?
• I don’t know if this is a problem for you, but many of my patients are dealing with abusive relationships. Some are too afraid or uncomfortable to bring it up themselves, so I’ve started asking about it routinely.
• Violence affects many families. Violence in the home may result in physical and emotional problems for you and your child. We are offering services to anyone who may be concerned about violence in their home.

Asking directly

• Are you afraid of your partner? Do you feel you are in danger?
• You mentioned your partner’s problem with temper/stress/drinking. When that happens, has he ever threatened or hurt you?
• Every couple fights at times – what are your fights like at home? Do the fights ever become physical?
• Have you been hit or scared since the last time I saw you?
• Has anyone at home hit you or tried to injure you in any way?
• What kinds of experiences with violence have you had in your life?
• Do you feel controlled or isolated by your partner?
• Does your partner ever try to control you by threatening to hurt you or your family?
• Has anyone close to you ever threatened or hurt you?
• Does your partner ever hit, kick, hurt or threaten you?
• Have you ever been slapped, pushed or shoved by your partner?
• Have you ever been touched in a way that made you feel uncomfortable?
• Has anyone ever made you to do something sexual when you did not want to?
• Has your partner ever refused to practice safe sex?

SAFE Questions (oral, add sequentially as needed)
Ashur M. Asking About Domestic Violence: SAFE Questions. JAMA.1993;269(18):2367 SAFE Questions

1. What stresses do you experience in your relationships?
2. Do you feel safe in your relationship?

1. people in relationships sometimes fight. What happens when you and your partner disagree?
2. Have there been situations in your relationship where you have felt afraid?
3. Have you been physically hurt or threatened by your partner?
4. Has your partner forced you to engage in sexual activities that you didn’t want?

1. Are your friends and family aware of what is going on?