Primary care physicians' response to domestic violence. Opening Pandora's box.

OBJECTIVE To explore primary care physicians' experiences with domestic violence victims to determine the barriers to problem recognition and intervention in the primary care setting. DESIGN Ethnography, a qualitative research method involving the use of open-ended, semistructured interviews. SETTING An urban health maintenance organization serving a predominantly white, middle-income population. PARTICIPANTS Thirty-eight physicians, predominantly family practitioners (89%), were interviewed. RESULTS Analysis of the interviews revealed that physicians found exploring domestic violence in the clinical setting analogous to "opening Pandora's box." Their issues include lack of comfort, fear of offending, powerlessness, loss of control, and time constraints. CONCLUSION This study revealed several barriers that physicians perceived as preventing them from comfortably intervening with domestic violence victims. These issues need to be addressed in training programs. Further studies should be done to assess generalizability of these findings to other groups of physicians.