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

http://www.google.ca/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=_wlaMtDSGKhsQM&tbnid=rF3H1URsv62RSM:&ved=0CAUQjRw&url=http%3A%2F%2Fred-education.com%2F%3Fp%3D645&ei=GpkdUeumOemkyQHDpIGYCg&psig=AFQjCNGdAW0klUr24abldb6k-fVgdrTchg&ust=1360980512690821

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”

https://www.google.ca/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=RJpVRzMi90DUvM&tbnid=_Vwn1I-_kwTHMM:&ved=0CAUQjRw&url=https%3A%2F%2Ftwitter.com%2FMapleLeafSikh&ei=DZ0rUcTLIaPuyAGurIGQCQ&bvm=bv.42768644,d.aWc&psig=AFQjCNEaAO9zlAS59N7qtdAU4jD1-h4Hmw&ust=1361899125034198

282

injured women

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

2943

PRAISE-Multinational Study

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