Table 1

Roles and responsibilities of orthopaedic surgeons (adapted from the canadian orthopaedic association position statement on IPV - version 2 – december 2012)
Domain Simple things surgeons can do
Education and Awareness • Educate yourself about IPV.
• Consider IPV when diagnosing and treating patients.
• Be aware that disclosure is a voluntary act, and, therefore, the decision to disclose or not disclose must be respected.
• Be knowledgeable about counseling, shelters and social and legal services that are available locally and have hospital and community support contact information readily available, as well as toll-free help-lines for IPV. These resources are location-dependent but the USA and Ontario toll-free help line numbers are below:
National Domestic Violence Hotline (USA): 1-800-799-SAFE
Assaulted Women’s Helpline (Ontario): 1-866-863-0511
Asking About IPV • Bring up IPV in a conversational manner: “Because violence is so common in many people’s lives and because there is help available for people being abused, I now ask every patient about domestic violence. Is this something that is happening in your life?”
• Follow up with the three direct questions: “Have you been physically abused by an intimate partner?”,Have you been emotionally abused by an intimate partner?”,Have you been sexually abused by an intimate partner?” OR use a mobile phone app to assist in screening.
• A statement — such as, “I’d rather risk offending you than miss the opportunity to provide you with some information or possible resources that could help you in the future.” — can be very helpful in initiating a referral to social services and moving beyond the purely medical context.
After Disclosure • If the patient discloses IPV validate their feelings by telling them that the abuse is not their fault. Be non-judgmental, empathic and supportive throughout the interaction.
• Assess the patient’s safety (and the safety of any children) in the home. “Do you feel safe returning home today?”
• If the patient feels unsafe, and with her/his permission, initiate a safety strategy immediately through referral to social services or shelter as required.
• Provide care for the patient’s immediate injuries and orthopaedic-related issues.
• Take clear, legible, objective clinical notes, using the patient’s own words about abuse. Add diagrams or photographs, when appropriate. Should the patient be unwilling to talk about how the injuries were sustained or about the possibility of IPV, documentation and your impressions could be of benefit to the patient sometime in the future.
• Provide a referral and contact information for local hospital-based or community-based support services if the patient is open to it.
• In Canada, physicians are not legally obligated to report abuse of adults to the police. In some US states reporting of IPV is mandatory. Ensure that you know the legal requirements for your jurisdiction.
• If you believe that children are at risk, you must notify your local Child Protective Services agency. Ensure you know the reporting requirements for your jurisdiction.

Sprague et al.

Sprague et al. BMC Musculoskeletal Disorders 2013 14:23   doi:10.1186/1471-2474-14-23

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