As a doctor, I want victims of family violence to know they can come to me

When I was a family medicine trainee, a woman came in to obtain a signature on a form that would allow her insurance company to cover her orthotics. I thought this would be the easiest appointment I’d have all day. Forty-five minutes later, I walked out of the office, stunned. The woman revealed her husband had been abusing her for more than 40 years. She was disclosing it now, to me, for the first time.

Initially, she didn’t want to talk at length because her husband was waiting in the car, but I gave her a bogus explanation and some fake requisitions to help explain why I had kept her. I fumbled my way through some safety planning and she was gone. Mercifully, I saw her again, and I was, I hope, a little more prepared the second time around. I don’t know what happened to her in the end, but I think of her often and hope that our appointments were helpful.

I was recently reminded of that situation, and how ill equipped I felt to handle it, when I learned about the murder of a Toronto-area physician. I didn’t know her personally but, by all accounts, she was bright, vivacious and intelligent. Her husband, himself a neurosurgeon, is charged with first-degree murder.

It’s a coincidence that her death happened during the UN’s 16 Days of Activism Against Gender-Based Violence, an initiative aimed at ending violence against women and girls, but the moment provides some context for this horrible act.

Media headlines in the days following have focused on how “shocked” the medical community is, that we are “reeling” from the news of the loss of one of our own. Sure, it’s a surprise, but it really shouldn’t be. Women are subject to violence on a daily basis, and many of us see the effects of it regularly in our offices and hospitals.

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StatCan reported about 85,000 cases of family violence in 2014, with seven in 10 victims being women. In medical school, we all learn the same horrifying facts: Women who experience violence frequently do so at the hands of their partners and, since most women never report their abusers, the statistics we have are probably a gross underestimate. Even after a physically violent episode, most women don’t leave for complicated and often completely understandable reasons.

All that’s to say, we know violence against women is happening. Every day, Canadian doctors take great care to help women and families who have experienced it. Our job is to empower them with knowledge and resources, so they can make decisions about their own lives.

What’s really shocking is how spectacularly that system may have failed this woman. She was a physician who presumably had access to knowledge and resources, and she was surrounded by people trained to treat partner violence. Yet that wasn't enough. Giving people knowledge isn't enough. We need to help them translate it into action; we need to ask the tough followup questions every time.

As a family doctor, she, herself, would have helped others in their journeys, and taught the next generation of physicians how to ask questions sensitively, look for subtle signs of trauma and make safety plans. The medical community feels a deep sense of injustice because she could've taught others how to identify and treat partner violence.

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Since her death, I've seen some soul-searching in doctors’ lounges, both physical and online, about how we take care of women experiencing violence and what we can do better. Amidst calls for “better screening,” physicians are talking.

We’re sharing the strategies our patients have found helpful. We’re contacting the domestic violence officer in our community to introduce ourselves, so we know who our patients will be calling, if we recommend that resource. We’re sharing ways to ask questions, not just about physical violence but about all the psychological forms of violence that don’t leave marks for us to see. We’re looking for more opportunities to ask those questions. This messy and complicated conversation will be our colleague’s lasting legacy in our community.

So, as we get better at this difficult discussion, I feel like I can speak for all doctors when I say to Canadians: If you feel unsafe in your relationship, tell one of us. Tell your family doctor or your surgeon or your obstetrician or your psychiatrist or the physician at the walk-in clinic. You can tell us even if the visit is for your child, or you aren’t sure it’s relevant information. We think it’s terribly important. We promise to stay vigilant. We promise, we’re listening.

Aruna Dhara is a family physician in Nova Scotia.

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