Esther Choo, MD, MPH This week, the community of women physicians was rocked by the death of one in our midst, an anesthesiologist, intensivist, medical school faculty member, and mother, in an apparent domestic violence homicide. Dr. Casey Drawert (yes, we WILL say her name) was a highly accomplished physician married to a “prominent businessman” adding to the media-stickiness of the story. Her success clashes with our deeply entrenched biases about the demographics of domestic violence victims. Yet again, we were reminded that although certain groups may be more susceptible, domestic violence (I prefer the more specific term “intimate partner abuse”) is remarkably inclusive; its lifetime membership includes more than one third of women in the country. I would venture to guess that having survived partner abuse is the most unifying experience of womanhood second only to childbirth. So, of course it is not surprising that women physicians – and other well educated, well informed, and well resourced women and men – quite commonly experience abuse at the hands of an intimate partner.
Yet what renders this case particularly painful for us is that as physicians, we have a professional obligation to inquire about and address abuse. The fact that one of us was at risk and failed to get help is a profound and incomprehensible failure. The Facebook phenomenon Physician Mothers Group (PMG), a group honored to have Dr. Drawert as a member, has exploded with expressions of horror and sorrow, calls to action to help those experiencing abuse, as well as courageous posts from those who survived abuse and felt inspired to share their stories to encourage others to reach out for help.
In discussing this tragedy, a physician colleague asked me, “Are there reasons physicians might be less likely to report abuse?” In my clinical and research experience, I would say yes. The experience of partner abuse goes hand in hand with shame, guilt, and feelings of aberrancy and isolation. The abuser often makes the victim feel deserving of the abuse. On FemInEM and PMG, I see, day-to-day, how shame and guilt already underscore many of our conversations. We frequently ask, “Am I doing enough?” about every aspect of our lives. Whether in reference to specific patients, part or full time clinical practice, our children, our spouses, our parents, our extended families, our friends or our bodies, there is no limit to our own self-doubt and introspection. At the same time, social media is the place where we construct narratives of our lives, while guarding the most private and embarrassing parts. Where does an admission of an abusive relationship fit into the narrative of the successful and intelligent woman, especially in a cohort that is self critical and high achieving? Indeed, posts about unequivocally abusive relationships do appear on PMG anonymously – a recent one detailed exhaustive attempts to appease the abuser over the years. Many do not use the word abuse. They are all offered personal help and resources by PMG admin; it is not clear that any accept it. I suspect partner abuse joins depression and substance abuse as problems that women physicians experience disproportionately, while disproportionately under-reporting it.
I lecture regularly about partner abuse. During one talk, I polled the audience, asking who had ever experienced partner abuse or had a close friend or family member who had experienced it. Nearly two-thirds responded positively. I then asked who asked their patients regularly about partner abuse. About one-third responded in the affirmative. Finally, I asked who regularly asked their colleagues, friends, or family members if they were experiencing partner abuse. Not one person did this. I was not surprised; I myself do not do this. Asking remains uncomfortable, taboo. We physicians – this articulate, outspoken group – are rendered silent by the prospect of asking the simplest of questions: Are you safe in your relationship? Is anyone harming you? Can you tell me what’s going on?
Expecting victims to announce their abuse spontaneously is optimistic. We must be more than receptive; we must do active surveillance for abuse within our communities. And based on the known epidemiology of partner abuse, we should expect to find it regularly and to offer assistance, emotional and moral support, and referrals to the best of our ability. There is no simple solution to partner abuse: it has been with us since the beginning of mankind and is here to stay. What can change is our willingness to face it head on.
The National Domestic Violence Hotline: 1−800−799−7233 or TTY 1−800−787−3224.
Casey WAS a member of pmg. She had done all the right things, had all the right support, and still she’s gone. Screening alone isn’t the answer.
We are sorry we misspoke about her PMG membership. We know she did all the right things and despite that she was lost. Although we didn’t know her, we hope this helps honor the remarkable mother, physician and person she was.
Nor did we mean to imply that membership in PMG was a means to protection.
It is beyond tragic. I wish we knew how to prevent this from happening.
Great post. I would say that almost everyone has had a close encounter with intimate partner violence. A close relative, close friend, and kindergarten teacher were all victims.
Thanks for writing this. I am glad you admitted that you have a hard time asking friends and family, and that a third of women docs were able to ask patients; but we all need to be better at figuring out ways to get at this question, and to make the world safer for intimate partners. Tucking questions about safety into our conversations with patients is really important. Even if they don’t tell us at first, as the relationship evolves, they may feel more safety in getting our help. And thanks for working to make this issue more nationally known.
To be clear, you named Casey using the surname of her first husband, who is NOT the one who murdered her on Friday.
We used the name on her public profile and go fund me. We were not trying to refer to her killer in any way. Did she go by a different name?
Her newly married name was Casey Mitchell Ross. For much of her career she would have used Drawert. But as a friend of her first husband, I don’t want anyone thinking that he was the perpetrator.
Thank you for your thoughtful post. She was a true light in this world.
Thank you for posting this article. I was in the same training program as Casey. She was truly amazing.
As a licensed Marriage and Family Therapist who is a survivor of domestic violence, I can tell you that sometimes being highly educated, intellectually competent makes it even more difficult to admit to being subjected to partner violence. We hold ourselves to higher standard and multiply the amount of shame and guilt.
Acinta- Thankyou for this comment. I am a survivor of Intimate Partner Assault. I do agree so many believe that it doesn’t happen or shouldn’t happen to the highly educated or successful business people. I am in this list- successful, educated and well versed and it is a stigma that we must remove. I will be expanding my website to tap into this very fact as I continue to embrace my story to be a light for others. – Nicole Waters http://www.yourPAClife.com
Great, Nicole!! Thanks for doing the work and shining the light! Here in rural Texas it happens as anywhere else. When I was volunteering many years ago in Southern California, an educated woman drove into the shelter in a Mercedes.
Thank you Esther. What a tragedy. This piece is incredibly powerful. I