Recognizing Intimate Partner Violence — in Our Patients and Colleagues

November 25 marks the International Day for the Elimination of Violence against Women. As we discussed in a recent article in Dialogue magazine, CPSO considers violence against women – especially intimate partner violence (IPV) – a major issue, because it is a major health issue. But with the tragic 2016 murder of Dr. Elana Fric, we have learned that IPV affects not just patients but also Ontario’s physicians.

CPSO chief medical advisor Dr. Sheila Laredo, who joined us from Women’s College Hospital, has worked in this space of social justice advocacy her entire career. The Fric murder compelled her to think about how to get IPV more top of mind with her fellow physicians, so they might recognize the signs not only in patients but also in colleagues. “At Women’s College, we had been trailblazers in women’s reproductive health, in addressing violence against women,” she says, “but after the Fric murder, we thought: how do we address this as a social justice issue among physicians themselves?”

Prevention through education

What started out as Dr. Laredo’s idea for a public campaign soon morphed into an online learning module, Recognizing Domestic Violence in the Workplace: Training for Health Care Professionals, which is now available to all physicians in Ontario through their hospital networks. Partnering with numerous players in the province’s health-care sector, including Mount Sinai Hospital and UHN, the module was developed by a team of domestic and IPV researchers and clinicians.

One of them was Dr. Robin Mason of Women’s College, who has nearly 20 years’ experience working in the area of gender-based violence. She says key goals of the tool are to help physicians and other health-care professionals recognize just how pervasive the issue is, and to help break through the stigma and stereotypes that are often associated with IPV. “I think there’s this idea that victims of intimate partner violence only come from certain socio-economic groups, certain ethnicities, people who aren’t working in a ‘profession,’ etc.,” she says. “We wanted to challenge and confront physicians with those perceptions and make them realize IPV can happen to anyone, anywhere.”

Dr. Mason sees IPV not only as another health issue, but as a true epidemic, one that physicians need to be cognizant of among both their patients and fellow practitioners. Having a conversation with someone you worry may be experiencing domestic violence may be awkward, but Dr. Mason says identifying and addressing these issues are part of any physician’s professional practice. “When you have an emergency, you deal with the emergency,” she says.

Dr. Laredo agrees. When it comes to the pervasiveness of gender-based violence, she cites a statistic indicating that one out of six women who arrive at an Ontario emergency room presenting a fracture received that fracture as a result of IPV. “And these acts of violence are just as likely to happen to a physician as any other group,” she says. Discussing potential instances of IPV may be difficult, but Dr. Laredo likens it to any other uncomfortable conversation one might have with a patient, such as issues around sexual health. The more practice clinicians get with having these discussions, the less awkward they will become.

Asking the right questions

Of course, how one handles an instance of IPV when it presents itself is critical. Dr. Laredo says suggesting that the victim “just leave him” can do more harm than good, as separation can often act as an accelerant to the violence. Both Drs. Laredo and Mason say asking more appropriate questions is key. These include:

• Are you safe?
• Do you feel safe?
• How can I help?
• Do you have a safety plan?

The learning module walks physicians through ways to recognize the signs of IPV and how to address them appropriately with colleagues.

Thus far, the tool has been a major success. Dr. Laredo says nearly 5,500 Ontario physicians have already completed it, and Dr. Mason says that she had heard from colleagues who say they’ve found the module concise, well-organized and engaging. “One physician told me that it’s the most important and relevant online learning module they’ve done,” she says, “which is really great to hear.”