By Dr. Jaclyn Tomsic
IPV is a new word that is being heard more in medical offices. Also referred to as domestic violence, intimate partner violence (IPV) is a serious, under-reported, and preventable public health problem, and estimates show IPV affects up to 32 million Americans. Although it is more common among adolescent and adult women, IPV can affect anyone; women are more often victims than men, with significant physical, sexual, and mental health consequences.Â
Typically, at least 1 in 4 women and 1 in 7 men are victims of severe domestic violence from a partner at some point in their life. It’s important to emphasize that IPV has many forms, not just physical or sexual; it can be psychological, emotional, and mental and includes stalking. It can occur among people with any gender identity or sexual orientation and does not require sexual intimacy.
Even in this alarming global scenario, many health workers still have difficulties approaching IPV with women and providing care for the victims of this type of violence. All too frequently, IPV is undiagnosed since patients often conceal that they are in abusive relationships or situations due to perceived stigma as well as privacy and safety concerns. The clues pointing to abuse may be subtle or absent. Many groups advocate screening all or all female patients for IPV.
As a healthcare provider, I aim to raise the visibility of IPV because this is happening right under our noses and in plain sight. For healthcare providers to truly really realize that they can potentially play a significant role in helping these people by being a resource or a place of safety for these victims. And a place where patients can safely tell them information, know that it’s a safe place, and get help too.Â
As recommendations and guidelines from national associations and organizations, hospitals, and medical centers become more mandatory, the normalization of screening will become more commonplace and natural and, hopefully, make these types of questions the norm – for not only clinicians to ask – but also expected from patients and potential abusers. Therefore, it increases the likelihood of victims reporting and decreases the abuse itself.
Making these questions part of the standard medical conversation will help put patients at ease and increase their likelihood of disclosure. While also sending the message of the heightened awareness of IPV across healthcare and the medical stance that this behavior will not be tolerated.
One study in JOMS (The Journal of Oral and Maxillofacial Surgery) in 2010 suggests that combining information regarding injury location (head, neck, face) and a screening questionnaire (Partner Violence Screen or Woman Abuse Screening Tool) are together a better predictor of a woman’s likelihood to report IPV-related injuries than either modality alone. Studies suggest that the head, neck, and face location was a sensitive but nonspecific marker for IPV-related injuries.
What can we learn from this as providers?
When faced with a patient who we may suspect IPV – having a short IPV-screening questionnaire on hand for the patient is key.
Some risk factors of IPV or domestic violence include younger age, females, those with lower socio-economic status, and family or personal history of violence. All people who present with a history or findings consistent with undisclosed violence should be considered for IPV.
What to be on the lookout for? – Any injuries of non-verifiable or questionable etiology (assaults and falls) versus, for instance, victims of MVCs (motor vehicle collisions), as their etiology was verifiable. A young woman or man with HNF (head, neck, and facial) injuries is likelier to be an IPV victim than an older woman with HNF injuries.
When addressing IPV, the interview should be done privately with only the patient. Assure confidentiality and reassure that the patient feels safe and comfortable.
General Principles to Follow:
- Reassure that the patient feels safe and comfortable
- Do not use phrases “domestic violence,” “abused,” “battered,” or “victim,” but instead ask about being hurt or experiencing violence or fear, frightened or treated badly
- Be ready to listen
- Use open-ended questions – done in private
- Assure confidentiality
- Only ask a few questions – do not overwhelm the patient
Remember that the initial encounter may not lead to the victim leaving the relationship or reporting abuse to the police. Be sure to acknowledge the victim’s situation and support their autonomy, perhaps most importantly, acknowledge the complexity of the situation.
In cases where the IPV is not acknowledged initially – it is essential to ask the patient again at subsequent visits – this normalizes the inquiry, and some data suggest patients are more likely to disclose the information if asked repeatedly.
There is no gold standard screening method, but there are many options.
Recognizing the signs of IPV is the first step, but what do you do next?
With everything, documentation is vital. In addition to recording dental findings, document complete head and neck exams and document any other observable injuries on different parts of the body or physical signs of abuse. Also, be sure to document or note any quoted remarks by either patient or the person accompanying the patient. Assess where the victims are in this situation and realize that they may not be ready to leave their abuser the first time, or they may not be able to or are not ready to file a police report.
Remember to ask again at return visits. Repeatedly coming back to it, asking those questions, and offering that safe space creates trust and establishes compassion so that they may know where to go when they are ready and know that they have resources to access.
Dr. Tomsic is originally from Cleveland, OH. She attended the Boston University Goldman School of Dental Medicine in Boston, MA earning her Doctor of Dental Medicine doctorate. After graduation, she moved to Charlotte, NC to work at Carolinas Medical Center as a general practice resident, with a strong focus on oral surgery and oral medicine. Dr. Tomsic completed her oral and maxillofacial surgery training at the Detroit Medical Center in Detroit, MI. Dr. Tomsic then joined the Posnick Center for Facial Plastic Surgery, completing a one-year fellowship in jaw reconstruction, orthognathic surgery, facial plastic surgery and sleep apnea surgery at Georgetown University Hospital in Washington, DC. You can learn more about her work here and by following her on Instagram.
