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.