Doctors to ask patients: Are you a battered wife?

A report warns doctors that violence against women in the home is an "unspoken epidemic" and more needs to be done to identify abusers.

It claims five million women are victims of domestic abuse at some time in their lives, with around 350,000 incidents reported to the police each year.

Doctors are being sent guidance by the British Medical Association highlighting the impact of domestic abuse on health, ranging from direct injuries such as fractures and burns to psychological torment.

It says doctors need to ask patients the right kind of questions to determine whether they are victims and give them advice and support.

Women attending Accident & Emergency departments with an injury should be asked whether they have suffered domestic abuse, it says.

But the guidance could prove controversial, with some women being offended by blunt or inappropriate questions.

Doctors could also find themselves confronted by husbands and partners, angry at the suggestion they are abusers.

Professor Gene Feder, who helped write the report, said antenatal departments and A&E were most likely to pick up on the problem. For one in three female victims, the abuse started in pregnancy, he said.

Launching the guidelines yesterday in London, he ruled out "routine" questioning of all patients seeking medical help, saying the evidence in favour of such an approach was not strong enough.

And he said questions had to be framed in the right way to "create the opportunity" for patients to disclose the nature of the abuse.

In hospitals they should be given privacy without relatives or partners being present.

Training for healthcare staff was currently lacking, he added, and the guidance gives a list of questions that can be used.

They include "Is everything all right at home?" and "I noticed you had a number of bruises. Could you tell me how they happened? Did someone hit you?"

The GP and professor of primary care research and development at Barts and The London NHS Trust admitted that patients could be upset if doctors or nurses approached the issue in the wrong way.

He said: "There is a risk that they can do more harm than good and training is vital."

In some parts of the UK, such as Worthing, West Sussex, A&E departments routinely ask injured patients about domestic abuse although the British Association for Emergency Medicine recommends questioning only when it is suspected.

The BMA's report says an A&E department with 55,000 patients of all ages attending during one year would see over 500 adult patients suffering due to domestic abuse.

A UK study in 2002 found there was a "high level of acceptability" among patients for routine inquiry about domestic abuse, either by a doctor or a nurse.

Professor Feder said abused women had a much higher risk of heart disease but the most likely effect was on mental health, where rates of depression were three or four times higher than normal.

But there remains reluctance among victims to recognise the harm being done, says the report.

The British Crime Survey shows that, of women experiencing domestic abuse, only 51 per cent thought their worst incident was a crime.

Some 13 per cent said they thought it was "just something that happens".

A spokesman for the Department of Health said: "This is an important area of discussion and we welcome the BMA's contribution to the debate.

"We recognise that healthcare professionals are uniquely placed to ensure that help and information is made available as early as possible."