Caring for the Intimate Partner Trauma Patient: Life Saving Tips

Escalation of physical violence is a key factor for intimate partner homicide.

The stark and brutal reality is that this woman sitting in your exam room may not survive a ‘next time’ to make it back to you.

Dr. Tornetta, “Orthopaedic surgeons have a unique opportunity to intervene as we are in a position to establish ongoing relationships with our patients. The leading cause of death 2002-2009 after domestic violence in North America was trauma. We should absolutely inquire about mechanism of injury and violence in the home/relationship.”

Dr. Tornetta, who has done research on surgeon perceptions of intimate partner violence, explains, “The first rule is, ‘Don’t make assumption about how something happened. If a woman says she fell down the stairs don’t assume that it was an accident.’ We are definitely missing many opportunities to serve our patients…only 12-17% of abused women have their experiences documented in a medical chart!”

“I am pleased to say that at Boston Medical Center our Emergency Department and social workers have led efforts to identify intimate partner violence and intervene early. Our center has devoted real resources to this problem, yet despite this, patients will fall through the cracks as they are not always honest about their injuries. The situation at many other institutions is not as aggressive or responsive and most of these physically and psychologically scarred patients are falling through the cracks.”

Joining Dr. Tornetta in this critical research is Dr. Mo Bhandari, chair of the division of orthopedic surgery at McMaster University, his wife—a social worker—Sheila Sprague, Ph.D., associate director at the Centre for Evidence-Based Orthopaedics at McMaster University, who for years have led international efforts to assess and address intimate partner violence, Gregory J. Della Rocca, M.D., Ph.D. and Prism S. Schneider, M.D., Ph.D.

Barriers to Progress…

Dr. Tornetta and his colleagues are committed to educating physicians about intimate partner violence. “You have a woman coming in who feels ashamed and scared and who may feel that she doesn’t deserve help. You might hear, ‘He is not always abusive’ or, ‘My injuries aren’t that bad.’”

“On the physician side, there is an enormous lack of education of this subject. And even when providers do get the appropriate information, they often feel that is it not their place to intervene.”

“In two surveys of members of the Canadian Orthopaedic Association, 56% had seen intimate partner violence in at least one case, and 73% had no guidelines for identification or management. When respondents were asked if there was a lack of knowledge of the appropriate resources, 95 agree, 19 were unsure, and 66 disagreed.”