Dialogue Volume 15, Issue 3 2019 - Page 44

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 44 DIALOGUE ISSUE 3, 2019