UofTMed Alum: We Were Treating Victims of Abuse, and Had No Idea

I was surprised one evening in December 2003 when my wife — a social worker with a focus in care of victims of domestic violence — began asking me details about the management of serious bone fractures.

Even though I was specializing in orthopaedic trauma, and we’d been married five years, she’d never before taken an interest. I knew it wasn’t mere curiosity.

She explained how many women arriving at a centre for victims of violence in Minneapolis, where she worked at the time, had been treated for serious fractures as a result of abuse — including fractures of the pelvis, humerus, clavicle and ankle, as well as dislocations of various joints. I knew — without a doubt — that an orthopaedic surgeon would have been involved in care for every one of these.

Yet the next day, I asked the surgeons I was working with in my trauma care fellowship if they recalled treating any patients with fractures incurred by domestic violence. The response was a resounding “no.” Not one could remember the last time they’d seen a case.

The absolute disconnect was startling.

It began a 15-year journey to educate myself, research the prevalence of intentional injuries among women in our fracture clinics, and tell anybody who would listen about the issue.

Through extensive surveying, we found that around one in every 40 women coming into Canadian fracture clinics were there as a direct result of intimate partner violence. And they hadn’t divulged the abuse (apart from in our confidential survey), because they had never been asked. (One in three reported having a history of abuse, and for one in 10 that abuse had involved physical violence.)

We were treating victims of abuse in our clinics every day yet we had no idea. We were looking no further than their physical injuries — seeing the limbs, but not the lives in front of us.

But when I approached leaders in orthopaedic surgery about the need for surgeons to recognize signs of abuse, and to help victims find support, I was told it wasn’t our issue and should be left to social services. That this would open a can of worms. This was in 2005 and the prevailing attitude was that, as busy orthopaedic surgeons, we just didn’t have time.

I thought differently: surely we had the responsibility to do more — to use our privilege to treat the patient and not just the injury.

The culture shift I thought we needed was big, but at the time I was intently focused on small, incremental goals — educating myself about domestic violence, collecting critical data in our clinics and spreading the word through advocacy.

Change can be painfully slow. If I look back, it was seemingly a 1,000 small wins — and at least 2,000 setbacks. Anyone involved in research and advocacy can relate to this.

It was a slow process but things did change. Our international research into the prevalence of victims of abuse in fracture clinics was published in The Lancet and showed similar results to our Canadian studies. The Canadian Orthopaedic Association now includes intimate partner education and advocacy among its top priorities.

And hundreds of clinicians are engaging in our “Educate” knowledge translation program, which provides educational resources and training for surgeons across Canada to respond effectively to patients who have experienced intimate partner violence.

When orthopaedic surgery — a surgical specialty made up approximately 99 per cent of male clinicians (another issue we need to work on) — makes violence against women a number-one priority, I feel reassured that things are changing.

While a lot more needs to be done related to abuse, at least we are setting out to do our part to help victims of violence in our communities — because intimate partner violence isn’t just a social issue, it’s our issue.

Dr. Mohit Bhandari, MD ’94, is Professor and Chair at McMaster University’s Division of Orthopaedic Surgery and Canada Research Chair in Evidence-Based Orthopaedic Surgery. He has received the Order of Ontario and was named member of the Order of Canada this year, for his research and advocacy related to intimate partner violence and the role of orthopaedic surgeons.