Panelists encourage surgeons to identify IPV in colleagues—before it’s too late

Intimate partner violence (IPV) is a public health problem that surgeons encounter frequently in patients, but may less commonly anticipate spotting in their colleagues. After all, surgeons and other physicians are well-paid, well-educated, no-nonsense people. But the reality is that health care professionals are as at risk as their patients, American College of Surgeons (ACS) Past-President Barbara Lee Bass, MD, FACS, FRCSEng(Hon), FRCSI(Hon), FCOSECSA(Hon), noted during a Panel Session, Intimate Partner Violence and the Surgical Workforce, on Tuesday, October 29, at Clinical Congress.

In 2016, Sherilyn Gordon, MD, FACS, a transplant surgeon and associate professor of surgery, Houston Methodist, TX, where Dr. Bass is the John F., Jr. and Carolyn Bookout Presidential Distinguished Chair, department of surgery, was murdered by her husband. He had been abusing Dr. Gordon for some time.

The incident came as a shock to Dr. Gordon’s colleagues. As chair of the department of surgery, Dr. Bass knew it was her responsibility as a leader to develop an institutional response plan.

“The initial response is to stop all else,” Dr. Bass said. People need time for grief recovery—to recognize our own feelings and then articulate the loss for others and yourself. Speak to the victim’s gifts and your shared experience. “Then start digging deeper” and talk to the people who dealt with the person every day—in this case, the victim’s surgeon colleagues, her residents, her nurses, her mentors and mentees, and so on.

Dr. Bass found that health care professionals who are in the high-risk cohort for IPV, including young women, young mothers, and members of the LGBTQ community, were particularly shaken and needed extra support. She outlined the principles applied in responding as an institution “to turn loss into positive action” as follows:

  • Look at the loss experience personally and collectively
  • Consider the immediate and long-term consequences
  • Look for professional assistance that will have the highest impact

“We all have to own this problem,” Dr. Bass said. “We have to be able to identify the people who are the highest risk for harm. We have to train each other and be knowledgeable about the signs that there is a problem.”

Harise Stein, MD, an obstetrician-gynecologist from Mountain View, CA, and associate professor, Stanford University, CA, offered insights into the characteristics of potential IPV victims in the health professions. Often these individuals had difficult childhoods, experiencing poverty; sexual, physical, or emotional abuse; or bullying. They may suffer from impostor syndrome, believing they are not good enough or smart enough to cut it as a physician, or they may be perfectionists who expect negative consequences when they make a mistake.

“Abusers are experts at finding these vulnerabilities, and they prey on them, especially sociopathic abusers,” said Dr. Stein, noting that 25 percent of abusers are sociopaths.

Surgeons may have a particularly difficult time extricating themselves from abusive relationships. “Physicians want to help people. We are drawn to those in need,” said Dr. Stein, noting that this may predispose physicians to stay with people who seem to require their help. They think they can “fix” the abuser.

Because of the intense training involved in becoming physicians, they may have less experience with what is involved in a satisfying relationship, she added. “Abusive relationships are often a complicated combination of initial love and subsequent fear,” Dr. Stein said.

Dr. Stein described some red flags to look for to determine whether abuse is occurring and may escalate, including being told that a partner has anger management issues. Other indications include working longer hours and showing signs of burnout or fatigue.

Brigid McCaw, MD, MPH, FACP, an internal medicine specialist from Richmond, CA, also described signs of abuse, including changes in mood or appearance, less ability to concentrate or make decisions, social isolation, and irritability.

If you believe a colleague may be experiencing IPV, “don’t underestimate the impact of letting the victim know that someone cares, nonjudgmental listening, reinforcing self-esteem, offering resources, and providing hope,” Dr. McCaw said.

Some institutional resources she suggested include employee assistance programs, counselors, human resources, and hospital security. Outside resources she suggested include the National Domestic Violence Hotline and myPlan, which is an online service for people trying to escape IPV.

Dr. Bass assumed the ACS presidency in 2017, soon after Dr. Gordon’s death, and quickly established a goal of addressing the issue. She co-founded the ACS IPV Task Force with Patricia L. 
Turner, MD, FACS, Director, ACS Division of Member Services, according to Carrie Sims, MD, PhD, FACS, associate professor of surgery, Hospital of the University of Pennsylvania, and the Presbyterian Medical Center, Philadelphia, and a member of the IPV Task Force.

The task force’s first accomplishment was attaining approval of a revised ACS Statement on IPV in June 2018, Dr. Sims said. “The College previously issued a Statement on IPV that focused on IPV in patients, but this revised statement added a focus on IPV in health care professionals,” Dr. Sims said. The IPV Task Force also published several articles on the topic in the October 2018 issue of the Bulletin of the American College of Surgeons, added a section on identifying IPV to the ACS Fundamentals of Surgery Curriculum, and released an IPV Toolkit. Dr. Sims encouraged potential victims to read the sections titled “How Do I Recognize if I’m in Danger?” and “Planning for Safety.”