HEALTH CARE * LES SOINS
NB pysicians sent hard-hitting discussion paper on wife abuse
Patrick Sullivan T wo years ago Dr. Lesley Pinder visited Papua New Guinea, where the men painted themselves for singsongs and adorned their wigs with plumes taken from the bird of paradise and the women and children lived with the pigs. A local judge had just admonished a man who had beaten one of his wives to death, warning him: "Next time, make sure you hit them in places that won't kill." It was not much like home. Or was it? Pinder, from St. Stephen, NB, chairs the New Brunswick Medical Society's (NBMS) Subcommittee on Family Violence and makes a strong case that the situation in Canada is not as different as Canadians think, particularly when it comes to wife abuse. In a hardhitting discussion paper that was distributed recently by the NBMS, she recalled the 1982 report of a House of Commons committee that stated: "We have been given good reason to believe that every year in Canada one-tenth of women who live as a couple with men are battered." Pinder also remembers the politicians' response. "This report Patrick Sullivan is CMAJ news and features editor. 218
CAN MED ASSOC J 1990; 143 (3)
"The reasons for the poor diagnostic record of physicians in this area are complex, but they stem from insufflcient knowledge of family violence or an unwillingness to become involved, or both." Dr. Lesley Pinder
was greeted in the House by jeers, laughter and catcalls. I heard these hoots, as did many people, but the television cameras did not swing to the sources. The names of those elected officials who apparently viewed the abuse of women as a source of amusement are unknown and unrecorded." She says the response of the judicial system is equally dismal, quoting Professor Donald Dutton of the University of British Columbia, who reported that for every 10 000 domestic assaults on women only two men will be convicted. According to Dutton, "a case can certainly be made that the criminal justice system appears to tacitly condone wife assault". Pinder makes an equally strong case that physicians do not do enough to halt this violence, simply because they are slow to recognize it. In fact, a home for battered women in Toronto reported that taxi drivers provided as many referrals as doctors. "The reasons for the poor diagnostic record of physicians in this area are complex", argues Pinder, "but they stem from insufficient knowledge of family violence or an unpreparedness or unwillingness to become involved, or both." Pinder, who wrote the discussion paper "to help physicians look at domestic violence from a woman's perspective", says doctors must get rid of misconceptions and stereotypes. "It would be erroneous to think that only poor, uneducated women are abused. One of my medical school classmates told me of her horrific experience with a violent ex-husband, who succeeded in convincing her that she was incapable of practising medicine. She succinctly observed that our coverage of the subject in behavioural science class had been of no practical value when she found herself in this unbelievable situation." Pinder says physicians,
The family violence paper is one in a series of four. "We have had a number of calls as a result of this first one and the response has been positive." David Balmain
whether they realize it or not, are seeing many abuse victims. And they see them regardless of their specialty. For instance, she points out that the first beating most often occurs during the first pregnancy. Because doctors are, after police officers, the most likely people to come face to face with domestic violence, Pinder says they should ask pointed questions about possible abuse whenever a female patient's injuries are inconsistent with the stated history. She also says that much of the chemical dependency found in female patients is related to abuse in the home. "Women keep returning to their abusive spouses for many reasons but always in the hope that things will improve, that the good periods between episodes of violence will continue indefinitely", Pinder concludes. "Physicians need to provide a lot of encouragement. We need to be listeners and to understand the issues. We need to be familiar with the community services and a woman's options. If there is a concern for the immediate safety of the patient and her children we must know whom to contact. And when they return and it has all hap-
pened again, we must exercise patience." David Balmain, executive director of the NBMS, says Pinder's discussion paper is one in a series of four papers the society is preparing. The others will deal with the physical and sexual abuse of children and the abuse of seniors. He says the society's discussion papers are not statements of policy, but are meant to encourage physicians to discuss sensitive issues. "We have had a number of calls as a result of this first one and the response has been positive", Balmain says. "Obviously there is some deep-seated reluctance to admit that a problem with doctors' response to wife battering does exist. But we have been working closely with our new Subcommittee on Family Violence and we felt there was a need for physicians to look at these potential problems." Copies of the discussion paper are available from the NBMS, 176 York St., Fredericton, NB, E3B 3N8. It is accompanied by a pamphlet, based on one produced by the Ontario Medical Association, that lists support services available to New Brunswick's battered women.CAN MED ASSOC J 1990; 143 (3)
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NB pysicians sent hard-hitting discussion paper on wife abuse
Patrick Sullivan T wo years ago Dr. Lesley Pinder visited Papua New Guinea, where the men painted themselves for singsongs and adorned their wigs with plumes taken from the bird of paradise and the women and children lived with the pigs. A local judge had just admonished a man who had beaten one of his wives to death, warning him: "Next time, make sure you hit them in places that won't kill." It was not much like home. Or was it? Pinder, from St. Stephen, NB, chairs the New Brunswick Medical Society's (NBMS) Subcommittee on Family Violence and makes a strong case that the situation in Canada is not as different as Canadians think, particularly when it comes to wife abuse. In a hardhitting discussion paper that was distributed recently by the NBMS, she recalled the 1982 report of a House of Commons committee that stated: "We have been given good reason to believe that every year in Canada one-tenth of women who live as a couple with men are battered." Pinder also remembers the politicians' response. "This report Patrick Sullivan is CMAJ news and features editor. 218
CAN MED ASSOC J 1990; 143 (3)
"The reasons for the poor diagnostic record of physicians in this area are complex, but they stem from insufflcient knowledge of family violence or an unwillingness to become involved, or both." Dr. Lesley Pinder
was greeted in the House by jeers, laughter and catcalls. I heard these hoots, as did many people, but the television cameras did not swing to the sources. The names of those elected officials who apparently viewed the abuse of women as a source of amusement are unknown and unrecorded." She says the response of the judicial system is equally dismal, quoting Professor Donald Dutton of the University of British Columbia, who reported that for every 10 000 domestic assaults on women only two men will be convicted. According to Dutton, "a case can certainly be made that the criminal justice system appears to tacitly condone wife assault". Pinder makes an equally strong case that physicians do not do enough to halt this violence, simply because they are slow to recognize it. In fact, a home for battered women in Toronto reported that taxi drivers provided as many referrals as doctors. "The reasons for the poor diagnostic record of physicians in this area are complex", argues Pinder, "but they stem from insufficient knowledge of family violence or an unpreparedness or unwillingness to become involved, or both." Pinder, who wrote the discussion paper "to help physicians look at domestic violence from a woman's perspective", says doctors must get rid of misconceptions and stereotypes. "It would be erroneous to think that only poor, uneducated women are abused. One of my medical school classmates told me of her horrific experience with a violent ex-husband, who succeeded in convincing her that she was incapable of practising medicine. She succinctly observed that our coverage of the subject in behavioural science class had been of no practical value when she found herself in this unbelievable situation." Pinder says physicians,
The family violence paper is one in a series of four. "We have had a number of calls as a result of this first one and the response has been positive." David Balmain
whether they realize it or not, are seeing many abuse victims. And they see them regardless of their specialty. For instance, she points out that the first beating most often occurs during the first pregnancy. Because doctors are, after police officers, the most likely people to come face to face with domestic violence, Pinder says they should ask pointed questions about possible abuse whenever a female patient's injuries are inconsistent with the stated history. She also says that much of the chemical dependency found in female patients is related to abuse in the home. "Women keep returning to their abusive spouses for many reasons but always in the hope that things will improve, that the good periods between episodes of violence will continue indefinitely", Pinder concludes. "Physicians need to provide a lot of encouragement. We need to be listeners and to understand the issues. We need to be familiar with the community services and a woman's options. If there is a concern for the immediate safety of the patient and her children we must know whom to contact. And when they return and it has all hap-
pened again, we must exercise patience." David Balmain, executive director of the NBMS, says Pinder's discussion paper is one in a series of four papers the society is preparing. The others will deal with the physical and sexual abuse of children and the abuse of seniors. He says the society's discussion papers are not statements of policy, but are meant to encourage physicians to discuss sensitive issues. "We have had a number of calls as a result of this first one and the response has been positive", Balmain says. "Obviously there is some deep-seated reluctance to admit that a problem with doctors' response to wife battering does exist. But we have been working closely with our new Subcommittee on Family Violence and we felt there was a need for physicians to look at these potential problems." Copies of the discussion paper are available from the NBMS, 176 York St., Fredericton, NB, E3B 3N8. It is accompanied by a pamphlet, based on one produced by the Ontario Medical Association, that lists support services available to New Brunswick's battered women.CAN MED ASSOC J 1990; 143 (3)
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