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Information and Choice rather than Screening by the Back Door

Posted by plosmedicine on 30 Mar 2009 at 23:37 GMT

Author: susanne McCabe
Position: retired
Submitted Date: October 21, 2004
Published Date: October 25, 2004
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

In a previous paper (BMJ 2003, Abuse, Women and Healthworkers), Ann Tasket and colleagues defended against respondents concerns about routinely asking women about abuse. 'With regard to the acceptability..most studies indicate that a minority of women do not want to be asked.....two studies indicate figures of less than 50%..'And go on to ask for further research into effectiveness and acceptability. Less than 50% can be a significant number, the actual numbers in such studies are needed. 50% of how many?
In the article in PLoS A.T. states that 'It is only a small minority of women who object to being asked'. the figues need to be transparent.'Women who have experienced abuse particularly value beng asked directly' This is too broad a statement...women have various ways of coping with abuse and make complex judgements not always conveyed to healthworkers/researchers as other studies show For some it can be a distressing experience with no beneficial outcome.

Nadine Wathen and Harriet Macmillan's view may be a harder message for researchers but they rightly focus on not just the absence of benefit but the potential harms accruing from routine screening. It is an imposition which can lead to increased surveillance and stigmatisation.
Already there are pilot schemes in the UK to kickstart a policy aimed at tagging all children with a number linking them to a GP.Any suspicion of a problem will be rcorded and shared amongst other professionals. It is women who are coming under increasing scrutiny in their private lives especially their parenting role. Women are right to be cautious about any disclosure.

Education, changes in the law, increased information, campaigns etc are slow but preferable to turning mre women into 'cases' on files.

Competing interests declared: None but I did respond critically to A.Ts previous article.