Dialogue Volume 15, Issue 3 2019 - Page 43

PRACTICE PARTNER PATIENT SAFETY We use this forum to regularly report on findings from patient safety organizations, expert review committees of the Office of the Chief Coroner, and inquests. Intimate Partner Violence: Broaching a Sensitive Topic with Patients E very family physician – knowingly or un- knowingly – has patients in his or her practice who are experiencing abuse at home. As such, FPs have a crucial opportunity to be a sup- port, perhaps even a lifeline, to such patients. About 7% of Canadian women, some 650,000, are es- timated to be victims of Intimate Partner Violence (IPV). That’s considered to be a conservative figure, due to underreporting. In fact, IPV is documented as the most common form of violence experienced by women, and is seen as a major underlying cause of poor health, and a significant public health issue. (Men can also be subjected to abuse but are much less likely to experience physical injuries than are women.) And yet large population-based surveys have shown that fewer than 10% of family physicians ask their pa- tients about violence in the home. There is no shortage of reasons why a family physician may be reluctant to broach such a sensitive subject – a lack of time, a lack of comfort with the issue, or a lack of knowledge about available supports. Some physicians may worry that they will offend the patient or it won’t make a difference if they do ask. Dr. Lopita Banerjee, a regional coroner and Brampton family physician, agrees that physicians may feel over- whelmed at the prospect of opening what they perceive will be a Pandora’s Box in the course of a 15-minute visit. But she suggests that physicians may be overestimating the load they will be expected to carry in the event of a positive disclosure. A patient’s disclosure of being abused does not tag the physician with the responsibility of solving the problem, she said. Physicians, she said, should be prepared to play a supportive role, not a curative role. “Clinicians have the sense that they must manage it alone. But this is not the case. We just need to open the door. Once we do that, there are resources and a commu- nity to help,” said Dr. Banerjee, who sits on the Domestic Violence Death Review Committee, an expert committee of the Chief Coroner of Toronto. Family physicians are uniquely positioned to ask, iden- tify and assist their patients, she said. “So many health conditions that women present with may be related to intimate partner violence effects, if not directly, then in- ISSUE 3, 2019 DIALOGUE 43