PRACTICE PARTNER
Other Issues to Keep in Mind When
Addressing Intimate Partner Violence Include:
nly ask the patient about
O
IPV when nobody else is in
the room.
Respond to the disclosure,
i.e., “I’m glad you told me
that", “How are you coping?”,
How can I help you?”, “Have
you spoken to anyone about
this before?,” etc.
Name the violence as abuse,
and remind the patient that
she is not to blame.
Express concern for
her safety, and remain
empathetic if she chooses
to remain in an abusive
relationship.
Assure her that the matter
will remain confidential,
except where suspected child
abuse requires you to inform
the Children's Aid Society
(CAS).
Have a list of local resources
and support information
on hand. These could be
obtained through the Public
Health Department.
Be aware of the risk factors
of IPV (see chart on facing
page).
Be aware of the risk
factors for lethality (past
strangulation, presence of
guns in the home etc).
Document your discussion.
Do not confront the abusive
partner if the partner is also
your patient.
Try to determine her level
of risk for serious harm,
and ensure she knows how
to contact the appropriate
resources (even if she does
not wish to access them
immediately).
For women who do not
appear to be in immediate
danger, do not tell them
what to do, do not tell them
to leave their partner, do
not recommend couples
counseling (which can
actually lead to an
escalation of violence), or be
judgmental. Simply explore
the consequences of each
option, and support the
woman’s decision.
Arrange for a follow-up
appointment.
For women in immediate
danger, encourage them to
stay with a friend or contact
shelter services, or, with their
consent, call the police. Also
encourage the woman to
develop a safety plan/escape
kit, i.e. emergency numbers,
key documents, a packed
suitcase (maybe stored at the
home of a trusted friend or
relative), money, etc.
directly. Abdominal pain, headaches,
mood disorders, chest pain – all are
examples of ailments that patients
present with and often can be trig-
gered by events related to IPV,” she
said.
She suggests that physicians
routinely ask their patients about
intimate partner violence in the same
matter-of-fact tone used for questions
about smoking, drinking or exercise.
“If you ask the question regularly, it
becomes less scary. It becomes just
another question about the patient’s
health,” she said.
Asking the question also signals to
the patient that the physician consid-
ers abuse a health issue. That may be
the first time that the patient sees it
through that particular lens, especially
if they grew up surrounded by abuse.
“I think that when a clinician sim-
ply asks the question of abuse, that
in itself is a huge support,” said Dr.
Banerjee.
In her own family practice, Dr. Ba-
nerjee uses the short version of WAST
(Woman Abuse Screening Tool).
1. In general, how would you
describe your relationship with
your partner? A lot of tension,
some tension, or no tension?
2. Do you and your partner work
out arguments with great
difficulty, some difficulty or no
difficulty?
A patient may not choose to indi-
cate that she lives with abuse when it
is asked the first time – or even the
fifth time – but the questions open
the door and create a safe space for
the patient to address the issue of
abuse at another visit, said Dr. Baner-
jee.
MD
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DIALOGUE ISSUE 3, 2019