Ep. 231 Intimate partner violence in our surgical patients with Dr. Lisa Cannada & Dr. Marissa Ullrich

🔹 Episode Overview

This episode explores intimate partner violence (IPV) in the orthopedic/surgical patient population — an issue surgeons encounter frequently but often fail to recognize or feel unprepared to address.

The discussion focuses on:

• Awareness
• Identification
• Surgeon responsibility
• Practical next steps

Key message:
👉 Surgeons see IPV regularly — whether they realize it or not.

👩‍⚕️ Guest Introductions

Dr. Lisa Canada

• Orthopedic trauma surgeon
• University of North Carolina School of Medicine – Charlotte Campus

• 25 years in practice

• Professional pillars:
  • Education
  • Mentorship
  • Clinical excellence
• Co-author of paper on IPV in orthopedic patients

Motivation: Bridging clinical care and education to help surgeons recognize hidden violence affecting patients.

Dr. Marissa Ullrich

• Third-year orthopedic surgery resident
• Mayo Clinic, Rochester
• Medical school: Ohio State University
• Passionate about whole-patient care

Key realization:
Medical training teaches mandatory reporting for:

• Children
• Elderly
• Vulnerable adults

➡️ But no standardized system exists for adult IPV screening.

🔹 What Is Intimate Partner Violence?

IPV is broader than many physicians assume.

Common Misconceptions

❌ Only married couples
❌ Only male-on-female violence
❌ Only long-term relationships

Reality

IPV can involve:

• Spouses
• Boyfriends/girlfriends
• Dating partners
• Roommates
• Caregivers
• Any gender combination
• Any age group

🔹 Why Surgeons Must Care

Surgeons often encounter IPV first because injuries bring patients to medical attention.

Examples include:

• Fractures
• Recurrent injuries
• Injuries inconsistent with reported mechanism
• Multiple prior visits

Orthopedic and trauma surgeons are uniquely positioned to identify abuse patterns.

🔹 The Hidden Gap in Medicine

Training emphasizes:

• Child abuse reporting
• Elder abuse reporting

But lacks:

• Standardized adult IPV detection
• Education on resources
• Clear clinical pathways

Result:
➡️ Physicians suspect abuse but don’t know what to do next.

🔹 Clinical Red Flags

Surgeons should consider IPV when they notice:

• Multiple injuries over time
• Vague or inconsistent injury history
• Injuries inconsistent with mechanism described
• Frequent “falls”
• Delayed presentation for care
• Partner answering questions for patient
• Patient reluctance or anxiety

Especially important in:

• Fragility fracture patients
• Elderly individuals with caregivers
• Repeat trauma presentations

🔹 Core Takeaways for Surgeons

1. You Are Already Seeing IPV

Statistically, surgeons encounter affected patients weekly.

2. Recognition Is the First Step

You don’t need to solve everything — awareness matters.

3. Think Beyond the Injury

Treat the whole patient, not just the fracture or operation.

4. Pattern Recognition Saves Lives

Connecting repeated injuries can reveal abuse.

🔹 Cultural Shift Needed in Surgery

The episode highlights a broader shift:

• Moving from purely technical care → holistic patient care
• Expanding surgeon identity beyond operator
• Embracing advocacy and safety as part of surgical responsibility