Amber Cadick, PhD, HSPP
A 24-year-old male presents to your office with complaints of fatigue and pain. When you go to listen to his heart you notice some red marks on his chest. When inquiring about this he breaks down crying and unbuttons his shirt to reveal claw marks across his torso. He quietly confesses through sobs that his girlfriend has been physically abusing him for some time, and he doesn’t know how to exit the relationship.
During didactics you notice that one of your star residents is sleeping. She has moved her typical seat with her peers to alone on the side of the room. The next 3 weeks you notice her dozing often during the lectures. What should you attribute this to—laziness, fatigue, apathy? Other faculty have noticed, and some are thinking about talking to her concerning professionalism. Thinking back, you realize that she has been lingering by your office but not saying much. One day she comes into your office, closes the door, and begins to cry. She shares that she hasn’t been able to sleep at night due to a fear for her safety. She thought this change in her partner’s behavior would be temporary, but now she doesn’t know how to stop it. She feels trapped, isolated, and lonely. She notes it is hard to perform her job as a resident with this stress at home.
Posted in Group on Violence Education and Prevention
Tagged awareness, domestic violence, education, Family Medicine, harm, intimate partner violence, IPV, medicine, partner, screening, treatment, Violence
Jennifer Ayres, PhD
As a trauma psychologist, I find that my greatest challenge in working with survivors of Intimate Partner Violence (IPV) is contending with my automatic bias that the “happily ever after” includes my patient leaving his or her perpetrator. When my bias arises, I reflect on three truths I learned from my undergraduate employment at a battered women’s shelter.
- Most people go back.
- If he or she goes back, and you made it clear that you thought it wasn’t a good decision, the patient can’t return to you the next time.
- It will happen again.
And there are a couple truths I’ve learned since I worked at the shelter.
- Basic decisions become complicated when you consider all the repercussions.
- Leaving might not be the best decision.
- If he or she does leave, the resources often aren’t available, and there is no referral for “make someone feel safe and free.”
These last three are challenging because I am much more comfortable with the patient who decides to flee the abusive situation or engage in the legal fight.
By Katherine Bakke, BA, Halley P. Crissman, BSc, MPH, Vijay Singh, MD, MPH, MS, and Arno K. Kumagai, MD, University of Michigan
Given their primary responsibility for the health and safety of their patients, physicians are the natural candidates to champion efforts to end intimate partner violence (IPV).1 According to the Centers for Disease Control and Prevention, nearly one in three women and one in four men report lifetime physical assault by an intimate partner, and IPV represents a leading cause of morbidity and mortality of women in this country.2 Medical education stands to play a key role in this area; however, with recent changes in the Liaison Committee on Medical Education (LCME) standards, the next generation of physicians may be even less likely to initiate conversations about IPV with their patients.
The LCME, which accredits all US and Canadian medical schools based on compliance with specific educational standards, recently announced reformatted standards that will come into effect after July 2015.3 Although perhaps not intended, the changes include a small but significant omission. In contrast to previous versions,4 the 2015 standards dropped violence and abuse as an example of a societal problem that should be covered in medical school curricula.5 While this omission may seem trivial, it is potentially of great consequence, for the risk of not educating medical students how to screen for, and assist survivors of, interpersonal violence threatens to perpetuate IPV as a significant, and more importantly preventable, cause of injury and death among women.
Posted in Education, Group on Violence Education and Prevention, Medical School
Tagged accrediation, domestic violence, education, intimate partner violence, IPV, LCME, Liaison Committee on Medical Education, medical school, standards