Action Trumps Hate: Addressing Misogyny and Domestic Violence

Domestic violence, rape culture, and sexual assault are gut-wrenching topics that many prefer to keep unseen and unheard, but it is too common and too debilitating to ignore.

Every now and again, we are reminded and reignited as a nation when a high profile celebrity publicly missteps. During this presidential election season we have been reminded of an attitude towards women that enables and propagates the sexism and misogyny that lends to domestic violence and sexual assault.

In the aftermath of a stunning Election Day result, liberals today ask “what now?” and “where do we go from here?” Public figures, from senators to entertainment celebrities, plead the people to channel their fear and self-pity into action. Emily McAllister and friends, for example, have already raised more than $10,000 in the first day to partially mitigate the $540m Planned Parenthood stands to lose. As a nation, we cannot afford to allow domestic violence, rape culture, sexual assault, or any other cousin of misogyny to continue unchecked.

While not everyone has personally witnessed or experienced this attitude towards women, “out of sight and out of mind” is a tempting but now inexcusable rationalization. Physicians, however, confront domestic violence, sexual assault, and the physical consequences of misogyny every day. One of the reasons I chose to enter orthopaedic surgery was the challenge – and privilege – of being able to fix what’s right in front of you. Right now, the problem is staring us in the face but we are yet to fix it.

One small piece of this concerning attitude towards women that needs complete reconstruction is how we approach female domestic violence. Doctors are mandated in most states to report abuse and neglect of children and the elderly, but for “competent” individuals between the arbitrary ages of 18 and 65 years of age, we have no obligation or supporting agency through which to report sustained abuse from domestic violence. Here I propose a case followed by a skeleton solution that may advance us forward as a society.

This past year, our surgical team and I met a 42-year-old woman named Rachel, who arrived in the hospital trauma bay with several injuries to the brain, spleen, ribs, pelvis, and forearm after a fall down the stairs. I recall her being not the most talkative patient, but did not think much of it since she remembered very little and reported loss of consciousness at one point. After delivering care from specialists in neurosurgery, internal medicine, orthopaedic surgery, and general surgery to treat her injuries, we decided she was “ready” to go home seven days later.

During her hospital course, we knew Rachel struggled with mental health. Our vigilant nurses informed us Rachel was exhibiting signs of schizophrenia as she would be often found pacing around the room muttering to herself. Every interaction we shared with her demonstrated disorganized thoughts, speech, and behavior. “Perhaps she needed to see a psychiatrist?” we thought, so our care coordinator helped us arrange an appointment for her after she was discharged. Just before her release, Rachel offhandedly told one of our nurses, “I can’t go home. He’ll kill me.” And suddenly, everything about the case changed. Aside from the fact that it was no longer safe for her to return home, her fall down the stairs was a thin veil for nothing short of brutal domestic violence.

With more guided questioning, Rachel cited several gruesome attacks by her spouse, including sexual assault. We correlated these with medical records from several outside hospitals that dated back over nine years. We found more and more poorly explained burns, genital injuries, fractures, and hospital admissions. Many surgeons had operated on her hand, her pelvis, and even her skull. Each event was explained away with one façade after the next. At this point, we once found ourselves asking which came first: the psychosis or the domestic abuse? Although we fixed Rachel’s injuries, we knew we were nowhere closer to healing her, and perhaps never would.

There seems to be a misconception that this kind of violence only happens to women in relationships with celebrities who can afford to treat others like objects. Cases like Janay Rice and Nicole Simpson are not isolated issues among a niche population. They represent dismissed symptoms of a growing systemic problem in our permissive society where everyday women like Rachel are left without the support to achieve basic safety and stability.

I propose a multi-step solution:

  1. We must accept that the problem is more common than we expect given one out of every three women will experience domestic abuse in her lifetime.
  2. The presupposition that individuals between the ages of 18 and 65 do not require protective services is not always appropriate, especially when the leading cause of female injury between ages 15 and 44 is domestic violence. This overlap all but mandates increased physician involvement.
  3. We must respect the complexity of domestic relationships, while appreciating the limitations of the current options. Despite the fact that most abuse incidences are repeat events, the abused may not always want to leave their spouse or partner. Even if Rachel could leave her husband, she doubted she could do so while providing for their three children. Pamphlets, hotline numbers, and resources are useful in the long run because they allows women to act on their own timeline with discretion. In the short run, restraining orders, family or friends, and shelters are available but may not always be accessible. Enough is not being done. While women’s shelters exist, they depend on donations from foundations and the private sector, with the occasional federally funded formula grant. As a result, many have closed due to lack of funding, personnel, or beds. In a single day, 65 percent of requests for temporary housing by victims of domestic violence go unmet. Furthermore, there exist at least two animal shelters for every shelter housing victims of domestic violence.
  4. We must harness the available technology and brave police offers to coordinate safety between physicians and law enforcement agencies. Today, we mute the victim’s cry for help and bury the physician’s suspicions deep within the electronic medical record. On the other hand, the 50% of police calls received related to domestic violence disputes may also get buried with even more dead-end documentation. One potential solution is building a database between physicians and local police departments that inform officers if a physician has flagged an individual as at-risk to provide officers with additional information that will further guide their actions. This solution is not unlike the online database from that tracks pawn shop receivables to alert police officers if thieves are cashing in on stolen merchandise.

Leveraging both doctors who treat the consequences of domestic violence on a daily basis and the local police force deserves to be routine practice to protect women suffering from domestic violence. Institutionalizing such a policy would discourage abusers and address the most extreme end of the misogyny spectrum. For many, the process of electing our next president has represented more than politics and exposed great social divides and fears. While it may appear there is not much we can agree upon today, at the bare minimum we must commit to valuing women in society as equal individuals. The commitment is an empty one if we do not more swiftly and unforgivingly curb the underlying philosophy of sexism and misogyny that leads to life-threatening consequences.

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