1. The Importance of Asking ALL Women About Safety in Their Relationships
Training UPDATE
THE CLINICAL SCENARIO
Ms. Murphy is a 21-year-old woman presenting to the fracture clinic with an undisplaced right tibia fracture. She is a competitive soccer player and states that her injury is the result of getting kicked by another player during a soccer match. An examination reveals no additional injuries or history of previous fractures. Ms. Murphy appears to a be a healthy woman with an active lifestyle.
Should you ask Ms. Murphy if she is experiencing violence in her relationship?
THE FOCUS
THE FACTS
When patients present with an injury that is congruent with the described mechanism of injury, and appear otherwise healthy, we may not feel as though we need to ask them about their safety in relationships.
We may feel uncomfortable broaching the subject with a patient who shows no outward signs of abuse
We may feel as though we would be able to tell if a woman was being abused based on her injury and presenting factors
Unfortunately that is not often the case. In fact, the majority of women who are experiencing current intimate partner violence (IPV) and present to the fracture clinic are NOT seeking treatment of an injury caused by IPV.
IPV victims who present to the fracture clinic for the treatment of an injury that was not caused by abuse, may still be experiencing physical abuse. IPV victims may also be experiencing non-physical forms of IPV such as stalking, emotional, psychological, or financial abuse. Non-physical forms of abuse have many negative health consequences for women and can be just as harmful as physical abuse. These forms of abuse can also be harder for health care professionals to detect.
While it may take a little bit of time to regularly ask about IPV, it is worth remembering that health care professionals routinely screen for other important health conditions that have much lower prevalence rates.
Breast cancer has a lifetime prevalence of 12%,
Colon cancer has a lifetime prevalence of 6%,
Cervical cancer has a lifetime prevalence of 0.6%
IPV has a lifetime prevalence of 33%
OUR RECOMMENDATIONS
1 in 6 women present to the fracture clinic with current IPV, but not seeking treatment for an injury caused by IPV
One in 50 women present to the fracture clinic for an injury caused by IPV
The only way for health care professionals to ensure that they are reaching out to all women experiencing abuse is to regularly ask every female patient about IPV, whether or not they appear healthy or they have injuries caused by violence. IPV is an extremely important health issue that is not possible to detect without regularly asking patients.
FURTHER CONSIDERATIONS
As you reflect on this, we encourage you to read about the experiences of two survivors of non-physical IPV in the BBC article entitled “Gaslighing: The ‘perfect’ romance that became a nightmare”. As you read this article, consider the ways in which non-physical abuse negatively impacted these women’s health and quality of life, as well as how health care professionals could have asked these women about abuse and provided them with assistance. The article can be accessed through this link: