DFCM alumna creates guide for family doctors to help survivors of domestic violence

By Alisa Kim

Statistics Canada data published in 2022 show about 6.2 million women in Canada reported having experienced some form of physical, psychological or sexual abuse in an intimate relationship in their lifetime. Rates of intimate partner violence in Canada are about four times higher among women than among men.

Domestic violence against women and girls intensified during the COVID-19 pandemic, leading the United Nations to call it “the shadow pandemic.” Increased isolation and unemployment brought on by the health crisis may be contributing to greater incidence of intimate partner violence, notes Dr. Bannuya Balasubramanaiam, a family and women’s health physician who completed her training at the University of Toronto’s Department of Family and Community Medicine (DFCM).

As part of her fellowship in women’s health, Dr. Balasubramanaiam worked in the Sexual Assault/Domestic Violence Care Centre at Women’s College Hospital. Caring for people experiencing domestic violence revealed the stark need to equip clinicians like her with the knowledge and tools to support these patients. “When I was doing the fellowship, I thought, ‘I’m going to be a physician in the community who’s going to face this—what are the resources? How do I do a good job screening for intimate partner violence in patients? And if I think they’re at risk, what do I do about it?’” says Balasubramanaiam, who was the 2021 recipient of the Elana Fric Family Medicine Award for Leadership and Advocacy. The award is given by DFCM in honour of Dr. Elana Fric, a faculty member of DFCM who in 2016 was killed by her husband. The award recognizes an outstanding family physician working to address and prevent intimate partner violence in the community.

With the support of her colleagues at Women’s College Hospital, Dr. Robert Dmytryshyn and Michelle Bobala, she developed an online guide for primary care providers to aid patients suffering domestic abuse.

The resource walks clinicians through recognizing signs and symptoms of domestic violence, screening for abuse in a trauma-informed way and reporting obligations once a disclosure of intimate partner violence is made. She also included an evaluation that identifies risk factors for death due to abuse. “It’s very important to let patients know that based on your assessment they are at high risk of death due to the violence,” says Balasubramanaiam, who has a family practice in Scarborough.

The first part of the guide deals with information gathering. The second part details how to provide first-line support to victims based on a strategy developed by the World Health Organization. It explains how to listen to survivors and inquire about their needs appropriately and help them put together a safety plan. Also included is a list of resources for housing, legal support, safety planning and crisis lines.

In putting the resource together, Balasubramanaiam says she wanted the information to be practical and easy for busy and time-strapped physicians to digest. “I kind of wanted it to feel more like a step-by-step plan,” she says. “I thought about how physicians learn and how I learn by lots of acronyms, organized strategies and algorithms. The information was out there, it was about putting it together.”

She says she hopes her colleagues in primary care will invest a few minutes to educate themselves on this topic as it could make a huge difference in the lives of vulnerable patients. “People are severely harmed by intimate partner violence every day in our community. The pandemic has only made the situation worse. If every individual that accesses this resource is willing to donate 10 minutes of their time to give the guide a skim, I do believe and hope it will put them in a position to provide really important support to patients when they have the opportunity.”