Julia Brant
Intimate partner violence (IPV), as defined by the Centers for Disease Control, is the “physical, sexual, or psychological harm by a current or former partner.†The Department of Justice currently estimates that 25 percent of women in the U.S. have experienced IPV at some point in their lives, while the American Cancer Society lists a woman’s lifetime risk of breast cancer as 12 percent. That women are more likely to experience harm from a partner than to develop breast cancer is a startling reality, but, despite these statistics, health care providers always screen for breast cancer but rarely for IPV. As a medical student in North Carolina, I have seen first-hand the effects of IPV exposure and I feel that this imbalance is unacceptable.
IPV is correlated with poor health outcomes. Several recent studies found a positive association between IPV and unhealthy behaviors in men and women, including binge drinking and smoking, both risk factors for a number of serious and potentially life-threatening diseases. Other research has reported that IPV exposure decreases T-cell function. T cells are an essential part of the immune system, and those with weakened T cells are more prone to illness and infection. In addition, there are a number of larger effects of IPV on health, including direct physical injury from assaults, chronic illness related to prior or repetitive injuries and stress, depression, financial hardships, withdrawal from friends and family and loss of spirituality. In 2007, more than one out of every eight homicides in North Carolina was due to IPV. IPV clearly has health consequences, including death.
There is no question that screening for breast cancer saves lives – with mammograms, we can reduce mortality from breast cancer by as much as 30 percent. So why don’t we screen for IPV at clinic visits? Screening for IPV is cheap. The most effective screening tools include survey questions – either oral or written. Screening questions can include: Do you feel in control of your life or relationship? Every couple fights – how do you and your partner argue? Do you ever feel afraid of your partner? Successful clinics that screen every patient for IPV do not report feeling pressed for time with the additional questions. Health care providers are in an influential position because they hold a position of respect and trust. Victims have reported feeling that providers can help and that being asked about abuse strengthens their relationships with their health care providers. Even victims who are not initially ready to disclose IPV have said that knowing someone cared enough to ask them helped them to feel more empowered.
In my own work screening for IPV in clinics, I have seen the need for universal screening and the benefits in my patients. However, the long-term benefits and the effects in a larger population are still unknown, because there has not been much follow-up of patients who received intervention services after screening positive. Many physicians worry that screening without knowledge of what to do next – after a patient admits to being a victim of IPV – may cause more harm than good. I would agree. In medical school, we are taught not only to recognize risk factors and disease states, but also how to treat. If we are going to successfully help patients who are affected by IPV, we must be able to follow-up our diagnoses. Screening is only the first step. I believe that the long-term benefit to universal screening will be seen once providers receive proper education about referrals and resources so they know what to do for a patient who has experienced IPV.
Many clinics in North Carolina offer screening, but are not connected to local resources. Most providers do not feel comfortable once the IPV “can of worms†is open. I believe that this will change if North Carolina provides IPV education for all the state’s health care providers. Kentucky requires all of its physicians to receive three hours of domestic-violence education for medical licensing. In just three hours of training, there was a significant difference in the comfort of Kentucky pediatricians to offer support and planning resources to victims of IPV compared to pediatricians from other states. Physicians never seem to have enough time, but the time required for this training is minimal. The benefits for the victims can be substantial and ultimately may save time and reduce health care costs in the future by reducing hospital visits and poor health outcomes.
Given the prevalence of IPV in the U.S. and its negative health effects, I call upon health care providers in North Carolina to take a stand and advocate for mandatory provider IPV training and education and universal screening for IPV in all clinics. I am not asking them to fix the problem, but to continue to do our duty to relieve suffering and save lives and be an activist for our patients’ health.
Julia Brant is a second-year medical student at UNC and co-leads a group that focuses on training medical students to identify intimate partner violence in patients.