In the United States, more than one in three women and one in four men experience some form of intimate partner violence in their lifetime. Healthcare workers are often the first point of contact for survivors of domestic violence.
Experts and advocates continue to push for more training for clinicians to identify and respond to signs among their patients.
Often missing from this conversation is the reality that those who carry out with screening victims – that is, the healthcare providers — can also be sufferers of intimate partner violence themselves.
Medical Professionals Face Domestic Violence
Healthcare providers rarely ask for support or disclose abuse at work. Some professionals — especially when the abuser is also in healthcare — have mentioned concerns regarding a lack of confidentiality, fears about colleagues’ judgment, stigma, and a culture that doesn’t prioritize self-care.
A 2020 study found that 24 percent of 400 physicians responding to a survey reported a history of domestic violence, with 15 percent reporting verbal abuse, 8 percent reporting physical violence, 4 percent reporting sexual abuse, and 4 percent reporting stalking.
Empathy and perfection are the strong points that medical professionals often pride themselves on. However, these qualities can make it harder for them to identify abuse in their own relationships and drive through shame and humiliation to search for help.
The majority of research on workplace violence is actually experienced by 62 percent of healthcare providers worldwide. And yet, intimate partner violence is still prevalent. Moreover, there are limited studies and discussion about intimate partner violence pertaining to medical professionals.
The problem has had dire consequences. In recent years, their abusers have killed many healthcare workers.
Tragedies Call For Screening
The need for healthcare professionals to screen each other as well as patients has grown. Even so, for an unknown number of survivors, breaking the silence is still not possible due to concerns about their professional consequences, reputation, and the threat of harassment from abusers who are often in the same field.
While a large majority has stayed silent, individuals who have spoken out say there’s a need for targeted interventions to educate medical professionals as well as more supportive policies throughout the healthcare system.
Although more studies are needed, research indicates healthcare workers experience domestic violence at rates comparable to those of other populations, whereas some data suggest rates may be higher.
Meanwhile, in an anonymous survey completed by 882 practicing surgeons and trainees in the United States from late 2018 to early 2019, more than 60 percent reported experiencing some type of intimate partner violence, most commonly emotional abuse.
Recent studies in the United Kingdom, Australia, and elsewhere show that significant numbers of medical professionals struggle with these challenges, as well.
A 2019 study of more than 2,000 healthcare assistants, midwives, and nurses in the United Kingdom found that nurses were three times more likely to experience domestic violence than the average person was.
Solutions to Health Professional Domestic Violence
More studies of healthcare provider-survivors as a unique group with unique risk factors are part of the solution.
In general, domestic violence is most prevalent among women. But young adults, such as medical students and trainees, can face an increased risk due to economic tension.
Major life changes…like relocating for residency, can also increase stress and unravel social connections, further isolating victims. In fact, it’s very difficult for healthcare professionals to report they are a victim of domestic violence.
Medical professionals are accustomed to being strong and move on. Identifying themselves as victims of abuse can appear like a personal contradiction. In effect, it may feel easier to separate their professional and personal lives rather than face a complex reality.
For example, in a personal essay, medical student Chloe N. L. Lee describes this emotional turmoil:
“As an aspiring psychiatrist, I questioned my character judgment (how did I end up with a misogynistic abuser?) and wondered if I ought to have known better. I worried that my colleagues would deem me unfit to care for patients. And I thought that this was not supposed to happen to women like me.”
Loraine, a licensed therapist, experienced a parallel pattern of self-blame when her partner began exhibiting violent behavior.
“For a long time, I felt guilty because I said to myself, You’re a therapist. You’re supposed to know this.”
At the same time, she felt driven to help him and sought couples therapy as his violence spiraled.
A Faulty System
Sometimes policies get in the way of the solution. In a 2021 qualitative study of interviews with 21 female physician-survivors in the United Kingdom, many said that despite the intense stress of abuse and recovery, they were unable to take any time off.
Of 180 UK-based midwife-survivors interviewed in a 2018 study, only 60 sought support at work and 30 received it. Many said their supervisors pressured them to report the abuse and get back to work. Then the supervisors either called social services behind the victim’s back, or reported them to their professional regulator.
One abuse victim recalled, “I was treated like the perpetrator.”
Barbara Hernandez, PhD, a researcher and director of Physician Vitality at Loma Linda University in southern California, says workplace violence and mistreatment from patients or colleagues — and a poor institutional response — can make those in healthcare feel as if they have to “shut up and put up.”
This type of response leads the way for victims to tolerate abuse at home. In addition, Dr. Hernandez adds, when survivors do reach out, there can be a disconnect between the resources they need and those they’re offered.
In a recent survey of 400 physicians she conducted, respondents typically said they would advise a physician-survivor to “get to a shelter quickly.” However, they admitted going to a shelter was the least feasible option. Support groups can also be problematic in smaller communities where physicians might be recognized or see their own patients.
Complications Abound
Complicating matters further, the violence often comes from within the medical community. This can lead to particularly malevolent abuse tactics like sending false accusations to a victim’s regulatory college or board; long-drawn-out custody or court battles to exhaust them of all resources and their ability to hold on to their job; or even violence at work, harassment, or sabotage.
On the other hand, the abuser’s public persona can guard them from any accountability.
For example, one physician-survivor said her ex-partner — a psychiatrist — coerced her into believing she was mentally ill, and claimed she was “psychotic” in order to take back their children after she left.
They also had many colleagues serve as character witnesses in court for him, saying, “…he couldn’t have done any of these things, how great he is, and what a wonderful father he is.”
Progress
After Sherilyn M. Gordon-Burroughs, MD, a Texas-based transplant surgeon, mother, and educator, was killed by her husband in a murder-suicide in 2017, her friends Barbara Lee Bass, MD, president of the American College of Surgeons, and Patricia L. Turner, MD, were spurred into action.
Together, they founded the ACS Intimate Partner Violence Task Force. Their mission is to educate surgeons to identify the signs of intimate partner violence (IPV) in themselves and their colleagues and connect them with resources.
D’Andrea K. Joseph, MD, co-chair of the task force and chief of trauma and acute care surgery at NYU Langone in New York predicts,
“There is a concerted effort to close that gap, making this a part of the curriculum, that it’s standardized for residents and trainees, that there is a safe place for victims… and that we can band together and really recognize and assist our colleagues who are in trouble.”
Resources created by the ACS IPV task force, such as the toolkit and curriculum, provide a model for other healthcare leaders. But there have been few similar initiatives aimed at increasing IPV intervention within the medical system.
What to Do
In her essay, Ms. Lee explains that a major turning point came when a physician friend explicitly asked if she was experiencing abuse. He then gently confirmed she was, and asked without judgment how he could support her. This approach mirrors advice from the National Domestic Violence Hotline.
She wrote:
“Having a physician validate that this was, indeed, an abusive situation helped enormously … I believe it may have saved my life.”
That validation can be vital. Dr. Abadilla urges other physicians to check in with colleagues, regularly. Especially those who seem particularly positive with an enterprising person attitude and yet may not seem themselves. That was how she presented when she was under pressure the most.
With regards to Loraine, she recently opened up to her mentor and other therapists — many of whom have shared that they’re also survivors.
“The last thing I said to [my abuser] is you think you’ve won and you’re hurting me, but what you’ve done to me — I’m going to utilize this and I’m going to help other people. This pain that I have will go away, and I’m going to save the lives of others.”
Supporting systemic changes within your organization and beyond is also important. Some medical professionals are even weighed down with a “double burden,” facing trauma at work and at home. This reality is noted by the authors of the 2022 meta-analysis, published in the journal Trauma, Violence, & Abuse.
Overall, of vital importance is the need for domestic violence training, legislative changes, paid leave, and union support. They are, in fact, an integral part of the solution.
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