West J Med
2000;172:301-304
Copyright © BMJ Publishing Inc.

Survivors of torture in a general medical setting
how often have patients been tortured, and how often is it missed?

David P Eisenman¹, Allen S Keller² and Glen Kim^3
1 UCLA Department of Medicine Division of General Internal Medicine Health Service Research
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,
MI 48109

Correspondence to: Dr Eisenman deisenman@mednet.ucla.edu

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 history.

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 Text]