West J Med
Copyright © BMJ Publishing Inc.
Survivors of torture
in a general medical setting
how often have patients been tortured, and how often is
David P Eisenman1,
Allen S Keller2 and Glen Kim3
1 UCLA Department
of Medicine Division of General Internal Medicine Health Service
B-551 Louis Factor Building Box 951736 Los Angeles, CA 90095-1736
2 Bellevue Hospital Center
D-401B Old Bellevue Building New York, NY 10016
3 Department of Medicine University of Michigan
School of Medicine Ann Arbor,
Correspondence to: Dr Eisenman firstname.lastname@example.org
Objectives To measure the frequency of people reporting
torture among patients in a medical outpatient
clinic and to determine primary care physicians'
awareness of their patients' exposure to torture.
Design Cross-sectional survey followed by selected
in-depth interviews of participants reporting a history
of torture. Medical record review and interview
of torture survivors' primary care physicians.
Setting The internal medicine clinic of
a large, urban medical center.
Participants A convenience sample of 121
adult patients who were not born in the United Statesand
who were attending the adult ambulatory care clinic.
Interventions All participants were interviewed using
the Detection of Torture Survivors Survey, a validated
instrument that asks about exposure to torture
according to the World Medical Association definition
of torture. Participants who reported a history of
torture were interviewed in depth to confirm that they had
been tortured. We reviewed the medical records of participants
who reported a history of torture and interviewed their
primary care physicians.
Main outcome measures Self-reported history of
torture. The awareness of primary care physicians of this
Results Eight of 121 participants (6.6% [95% confidence
interval: 3.1%-13.1%]) reported a history of torture.
None of the survivors of torture had been identified
as such by their primary care physician.
Conclusions Physicians of patients who
have not been born in the United States and who attend
urban general medical clinics frequently are unaware
that their patients are survivors of torture. Primary
care physicians can be the locus of intervention
in the care of torture survivors. The first step
is for physicians to recognize the possibility of
torture survivors among their patients.
This article has been cited by other articles:
Burnett, A., Peel, M. (2001). Asylum seekers and refugees
in Britain: The health of survivors of torture and organisedviolence.
BMJ 322: 606-609 [Full