Advocacy & Health Policy / Défense des intérêts et politiques en santé
Intimate Partner Violence: What Canadian Orthopaedic Surgeons Need to Know!
he COA and the Centre for Evidence-Based Orthopaedics (CEO) at McMaster University have recently renewed our partnership with a shared goal of raising awareness and providing educational tools to orthopaedic surgeons on the topic of Intimate Partner Violence (IPV). This edition of the
Bulletin features one orthopaedic surgeon’s personal experience discussing IPV with a patient, as well as an update on two collaborative initiatives between the COA and the CEO. We look forward to providing the membership with additional valuable updates in upcoming editions.
The Day I Decided to Ask Carrie Kollias, M.D., FRCSC Lethbridge, AB
t was my last, packed, clinic before holidays. A lady with an unhealed, four month old upper extremity fracture was sitting in the cast room. “How did this happen?” I asked. “I fell…”, she said, looking at the floor. “Any chance this happened from domestic violence?” She shook her head “no”. Her voice was hoarse, citing laryngitis. I felt awkward; I was not particularly skilled at these discussions. In fact, up until the week prior I rarely would have asked; knowing would be an inconvenience in a busy clinic. But I paused. A recent event had changed my perspective. “The reason I ask is that a colleague of mine was recently allegedly abused and murdered by her husband, and it has heightened my awareness of domestic violence.” I was of course referring to Dr. Elana Fric, an accomplished physician and devoted mother, whose death sent shockwaves through the medical community in Canada. My patient then burst into tears and began to tell me that her spouse had broken her arm when he tried to kill her. We later discovered that he had also tried to strangle her. Clearly he had almost succeeded since she could still hardly speak three months later… This experience was practice-changing; how many victims had I missed in my first five years of practice? As orthopaedic surgeons, we are in a unique position to help these patients, and not just with titanium or plaster. We need to be aware of resources for Intimate Partner Violence and processes to help. Most of all though, we just need to start asking a few simple questions. The EDUCATE Program: Education on Domestic Violence: Understanding Clinicians’ And Traumatologists’ Experiences Sheila Sprague, PhD Taryn Scott, MSW Mohit Bhandari, M.D., PhD, FRCSC McMaster University. Hamilton, ON Dr. Kollias shares an important experience - one which many orthopaedic surgeons may recognize from their own practice. IPV is much more common than we think. Research confirms one in six women who present to fracture clinics have been COA Bulletin ACO - Spring / Printemps 2017
victimized by IPV in the past year and one in fifty women are presenting for the treatment of injuries directly sustained from IPV1. Let’s dig deeper. Most orthopaedic surgeons in Canada feel under-prepared to appropriately identify, and equally as important, assist patients who disclose IPV in their practices2. EDUCATE is a Canadian Institutes of Health Research funded program developing critical tools to help orthopaedic surgeons and health-care professionals in fracture clinics identify and assist these women. It focuses on IPV knowledge and skill development delivered via an online video, three interactive online modules, and an in-person presentation that includes case studies and discussion. To implement the program, each participating fracture clinic identifies one or more local champions who become experts on the program curriculum and content and deliver it at their fracture clinic. Currently, the EDUCATE program has been implemented at six fracture clinics and is being qualitatively and quantitatively evaluated as part of a research study. The ongoing research study assesses: 1) Champions’ experiences implementing the program; 2) Program participants’ comfort and knowledge about IPV; 3) Participants’ readiness to assist IPV victims; and 4) Participants’ knowledge utilization. The evaluation of EDUCATE program will be completed by June 2018 and the results of the research study will be released at the COA 2018 Annual Meeting. The findings of the study will be used to refine the EDUCATE program prior to widespread use. The finalized program will be disseminated to the orthopaedic community through a joint collaboration with the COA and McMaster University. Please visit us at the EDUCATE Program booth at the upcoming COA 2017 Annual Meeting to learn more about IPV and the EDUCATE program. How Can I Change my Practice Right Now? Basic IPV Interventions for Surgeons The COA recently updated its IPV Position Statement and Best Practice Recommendations, as well as IPV Resource Appendix, with the help of the Centre for Evidence-Based Orthopaedics (CEO) at McMaster University. We recognize that IPV is a significant social determinant of morbidity and mortality, and that orthopaedic surgeons are well positioned to identify patients living with IPV and provide assistance. We recommend that all