Two vastly different experiences — serving as a “guest coach” on the sidelines for a Division I football team and volunteering in a busy emergency department — showed me just how unequal and damaging the lack of care provided for women who are victims of domestic violence can be.
In the first decade of the 2000s, one of the benefits of being a professor at Wake Forest University was the opportunity I received nearly every year to serve as a guest coach. A reward for supporting the academic endeavors of football players, it allowed me to stand on the sideline during home games. From that vantage point I saw — and heard — the hits that many players made and received, some hard enough to knock them out. I watched as the injured were ushered into the medical tent and put through the concussion protocol.
In addition to the physical and mental exams a player with a concussion undergoes, when a concussed player was enrolled in my class, I would receive a note requesting that he be excused from class to rest and recover and given extensions on his assignments. Among the many side effects of concussion is difficulty with headaches; screen time must be significantly limited, which affects a student’s ability to study, write papers, and take exams.
Around the same time, in the spring of 2003, my son graduated from Wake Forest University Medical school and, as a proud father of this newly minted M.D., I began a three-year volunteer position at the hospital connected to the medical school that trained him.
From my post in the emergency room, which was really just a desk located in a corner near a broom closet, I saw women come in with head injuries. But I never saw a staff member venture into that closet, which is where the forms were stored that helped nurses and other medical practitioners ask patients about their experiences with domestic violence.
Domestic violence has been identified by the Centers for Disease Control and Prevention as a threat to public health, with 1 in 3 women and 1 in 4 men having experienced severe physical violence perpetrated by a partner in their lifetime. For men who are victims of domestic violence, the violence they experience is more likely to be emotional and less likely to result in serious injury like concussion or strangulation. Among women, more than half of domestic violence episodes cause a concussion or other traumatic brain injury.
Coincidentally, I had just begun researching intimate partner violence, also known as domestic violence. As part of that work, I interviewed women who were beaten so severely by their partners that they lost consciousness, either because they were strangled or as a result of one or more blows to the head. Both of these types of violence can, and often do, cause loss of consciousness and injuries to the brain.
One woman I interviewed just weeks after being severely beaten with a ball-peen hammer showed me her shaved scalp and the stitches on her head. I was doing this research long before people were making the connection between domestic violence and concussions, so I never thought to ask her if she had been diagnosed with a concussion or if a police report had ever been filed, even though medical personnel are supposed to report domestic violence and provide resources to patients when they suspect it has occurred.
In the summer of 2022, I began another research project because I wanted to learn more about Black women’s experience with intimate partner violence and the barriers they faced to seeking help. I interviewed women who sustained serious head injuries or were strangled. While some of them had been arrested or referred to the Department of Child and Family Services, none reported that they were ever examined at the emergency room for possible head injuries or diagnosed with concussions.
My observations of unequal care are substantiated by physicians who reported in a recent webinar that, though they are aware of the requirement to document the injuries of patients who they believe may be victims of intimate partner violence — and specifically examine them for loss of consciousness as a result of either strangulation or head trauma — most don’t. Why not?
The featured speakers in the webinar offered three reasons: Most physicians lack the training to conduct the screening for exposure to violence. They had no idea what to do if someone screened positive. And they didn’t see it as an essential part of their job. In short, they made it clear that there are too many other tasks per shift to take care of, including treating life-threatening medical conditions.
But intimate partner violence should be considered a life-threatening issue, and one that must be carefully evaluated in order to provide crucial medical care.
As is the case for concussions sustained playing college and professional sports, no one knows the long-term consequences of concussions among victims of domestic violence. What is known is that the type of top-flight treatment that athletes receive when they sustain concussions should be what women who are victims of violence receive — but don’t.
Given that domestic violence occurs in every city across the country, it’s time to train all health care professionals to screen for domestic violence in its many forms, including concussion and strangulation. Specifically, students in pre-medical and pre-nursing tracks should be required to take a course that incorporates trauma and violence into the discussion of injury and treatment. Medical students, nursing students, and those training to be physicians’ assistants should be required to take an entire course that focuses on diagnosing, treating, and referring patients who have experienced head trauma or loss of consciousness as a result of violence.
Conceptualizing health care, especially in the emergency department, as a site of primary intervention in intimate partner violence would save lives and improve the health and well-being of all communities across the U.S.
Earl Smith is distinguished professor emeritus of American Ethnic Studies and Sociology at Wake Forest University in Winston-Salem, N.C., and a core faculty member in the Center for the Study and Prevention of Gender-Based Violence at the University of Delaware.
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