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Reducing Abuse
Moving Orthopaedic Surgeons
to Action!
Mohit Bhandari MD, PhD, FRCSC
Professor and Head
Canada Research Chair
Division of Orthopaedic Surgery
October 2013
Saying Isn’t Doing
Doing is Doing
Injuries are the
leading cause of
death for females
1 to 34 years old
43,000 women die from injuries
and approximately 1 million
women are hospitalized for
injuries annually
10 Years Ago
Domestic violence is the
most common cause of
nonfatal injury to women
4 in 10 women
experience some form of
abuse
physical assault 19%
rape 20%
intimate partner
violence 35%
Child Protection
Services
Involved in 50%
Cases
$50 Billion
263 women referred to DAP 2002-2003
We identified 144
physical injuries in 263
women
Fractures, Dislocations
and Severe Ligament
Sprains
2nd Most Common Manifestation of Physical Abuse
Implications
Women who have
experienced IPV are
seldom identified by
emergency physicians
A Second Chance…
Spectrum of Severity
Minor Severe
Fractures
How do you think
our surgeons
responded…?
Top Orthopaedic Journal
“I don't think it adds much to the
clinical practice of the orthopaedic
surgeon”
Top Trauma Journal….
“I just cannot see this as adding any value to the Orthopaedic trauma community. Social services is called after something like this and this does not impact our treatment methods in these cases.”
Not Our Concern
AAOS
1. Be knowledgeable about domestic violence
2. Appropriately screen and
3. Assess safety of the victim
4. Appropriately treat victims
5. Take steps to prevent further harm
The COA encourages members to
educate themselves about intimate
partner violence and considers it
good medical practice to take steps
to identify and offer assistance to its
victims.
20
13
Survey of Surgeons (COA)
184 surgeons
90% males
62% age <50yo
What Problem?
Majority
suspected <1%
injured women
victims of IPV
(Mis) Perceptions • Victim usually does
something to cause the violence
• 1 in 5 surgeons
• Victims choose to be a victim
• 1 in 6 surgeons
A Brighter Side
33%
support
education
Our Challenge • We believed IPV was grossly under-
estimated in orthopaedic practice
• Despite position statements, surgeons
did not agree
• Surveys suggested most surgeons
disregarded IPV in their practice due
to a key perception of “rarity”
1 in 11 injured women
disclosed history of physical
abuse in past 12 months
1 in 40 women
indicated the cause of
their current visit was
directly related to physical
abuse
0 women were
asked about IPV by their
treating orthopaedic
surgeons
1000 female patients per year
85 women disclosing physical abuse
25 women with fracture from abuse
Implications
PRAISE Worldwide
And here we are…..
Progress to Date • Peer reviewed publications
• Led the development of the COA’s Position
Statement on IPV
• Multiple symposia on IPV
• Completed a multinational prevalence study
• Building Bridges and Partners with many
individuals and organizations
Most surgeons paid little (if any) attention to
IPV as a cause of injury to patients
Asking women about ‘safety’ in a current
relationship was “opening a can of worms”
IPV was not a surgeon’s issue—we fix broken
bones
It wasn’t that long ago
The COA is the strongest supporter and
advocate for the safety of women in our clinics
[Position Statement 2009, revised 2013]
Leading Journals are now highlighting research
and education in IPV and orthopaedics
RCPSC are now including IPV scenarios in the
qualifying exams
Orthopaedic Clinics are piloting IPV toolkits
We can make a difference
• Continue to increase awareness
• Continue to change perceptions—one surgeon at a time
What Next?
Widen
Our
Lens
On average, every six
days a woman in
Canada is killed by her
intimate partner
Almost 1 in 2 persons
living on Earth are from
1 of 2 Nations
China 1.3 Billion People
India 1.2 Billion People
One Billion Rising
205 Countries Took to the
Street to increase
awareness about violence
against women
February 14, 2013
It’s our
Time to Act
1 in 3 women on the planet
will be beaten or raped in their
lifetime—over 1 billion women
who will experience some type
of gender-based violence
United Nations
“A woman is
beaten every
15 seconds”
“If I had seen something in
his office, about it, I would
have definitely felt more
comfortable bringing it up”
Educate
Anybody Who Will
Listen [even those that won’t]
Every Step Counts
Battered Child Syndrome Kempe
Federal law of mandatory
Reporting of Child Abuse 1974
1962
Knowledge Translation
• Aligning position statements on
IPV across all organizations
• Educating surgeons
• Participating in research to better
understand the role of surgeons
• Publishing widely and globally
• Developing “tools” for surgeons
Remember
Domestic violence is the leading
cause of injury to women
between ages 15 and 44 in the
united States - more than car
accidents, muggings, and rapes
combined ”
Saying Isn’t Doing
Doing is Doing
We have an opportunity make
a dramatic impact in the lives
of injured women in our
practices
This is not just a social
services issue she’s our
patient and it’s our issue
Thank
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