Imagine a situation where you are extremely tired at work and want nothing more than to freshen up, sit in your spot, put your feet up and relax watching your favourite Star Trek episodes with your significant other, but you would rather not leave the office at all because every time you step inside the privacy of your home, you have to walk on egg shells so that your significant other will not get ticked off and smack you on the head.
That is the typical day for a victim of Intimate Partner Violence. Home! That word surely brings up feelings of warmth and love for anybody. It is the place where a person need not wear any masks and is comfortable being themselves. But for victims of intimate partner violence, this liberating space becomes a personal hell. It becomes a space where their partner commits crimes on them with nobody to witness or give support.
Various researchers have described that there are four stages of an abusive relationship – seduction, social isolation, tension building and incident of abuse. In the seduction phase, the abuser charms the victim in the initial stages and builds an intimate relationship with them, in the social isolation phase, the abuser systematically removes the victim from all support structures including family and friends by means that include coercing a move to another city, the tension building phase is the phase before an overt act of abuse occurs but the victim is highly averse to angering the abuser, and the final phase is when the actual abuse occurs. Incidents of IPV are rarely reported to the police.
Intimate partner violence, or IPV is a leading cause of injury and stress throughout the world with frequent incidence of fatalities. The victims are at a greater risk of sexually transmitted infections, traumatic brain injuries, anxiety, depression and other chronic physical and mental problems. IPV is defined as physical, psychological, sexual and/or financial abuse that occurs between intimate partners.
Though IPV can be committed by both men and women, the overwhelming majority of the victims tend to be women, with prevalence among lesbian women twice as high compared to straight women. Many aspects of IPV have become normalized in patriarchal cultures around the world.
In Australia, in a survey conducted on 6677 women aged between 18 and 69, 23% women said they experienced IPV in the twelve months preceding the survey date. The results of the survey can be found here.
There is evidence that doctors in the GP or the ED setting are among the first professionals responding to IPV victims. On average, a GP may be seeing up to 6 women victims of IPV per week, but mostly fail to identify them. A study conducted by
the Providence Hospital ED in Washington DC concluded that a physician may be the only professional that an IPV victim sees, and that a battered person would reveal the true nature of their injuries if they were asked in the absence of their abuser.
Most doctors are well intentioned and want to do the best they can for their patients, but tend to ignore IPV because it is a completely new presenting complaint to them – they have not been taught how to deal with IPV during their medical school or training years.
According to Elaine Alpert, the former Assistant Dean of Student Affairs of Boston University School of Medicine, junior doctors in the States perceive that they have neither the time nor the expertise to deal with IPV effectively, hence they tend to ignore it. This fosters a “don’t ask-don’t tell” approach, and only helps to sustain the issue at a significant cost to the victim.
Recently there has been a paradigm shift in Australia with respect to a doctor’s duty of care towards an IPV victim. Many states have developed best practice guidelines for dealing with IPV which include advertising that victims talk to their doctors, but doctors are still underprepared. This is because, nothing has changed at the medical student and trainee doctor levels. There is a dire need to introduce a sexual health component during the training years. The guidelines themselves need to be made gender neutral because at the time of writing this post, they look at IPV as something that exclusively occurs in a heterosexual relationship where the woman is exclusively the victim. This precludes the possibility that patients who are homosexual and heterosexual men could also be victims. The general discourse on sexual health also needs to be expanded from just safe sex and STIs to include IPV and other issues important to women and sexual minorities.
There are some tell-tale signs of an IPV victim – the story they tell and the nature of their injury usually does not add up, they are quiet and spoken for (usually by the abuser), etc. But training is required to identify these signs and then effectively respond to the situation in a way that empowers the victim. Such training is currently not being provided. Until such training is provided during medical school and reinforced during training and later on as Continuing Medical Education, there is no use in urging the victims to talk to doctors and as future doctors we cannot say we will be doing our best for these patients; and this will stand in contradiction to our revered Hippocratic Oath.
National Project Manager – Red Party