On November 19, 2018, the country and the medical community were shocked by yet another mass shooting at Mercy Hospital Medical Center Chicago.  Dr. Tamara O’Neal, Officer Samuel Jimenez, and pharmacist Dayna Less were the victims of a lone gunman.  When an event like this happens, before details are known, so many questions are raised.  Was this a random shooting?  Was it gang violence?  Was it racially motivated?  Was the shooter a disgruntled patient?  As details emerged, it became known that the shooter, Juan Lopez, was the ex-fiancé of Dr. O’Neal.  This brings an often-forgotten fact to the forefront – more than half (54%) of mass shootings are related to intimate partner or family violence.

Intimate partner violence (IPV) encompasses physical, sexual, or psychological harm by a current or former partner or spouse.  Low income and low level of education are risk factors for IPV.  Unfortunately, Dr. O’Neal’s murder is a reminder that anyone of any educational or economic status can be in an abusive relationship.  One in 4 women and 1 in 9 men experience severe physical violence, sexual violence, and/or stalking.  IPV accounts for 15% of all violent crime.

IPV obviously has a significant impact on the victim but also affects families and society.  One in 15 children are exposed to IPV each year, the majority are eyewitnesses to the violence.  Victims of IPV lose a total of 8.0 million days of work each year.  Between 21-60% of IPV victims lose their jobs as a consequence of the abuse.  Almost one-quarter of workplace violence is related to IPV, the perpetrator gains access to a workplace and commits a crime targeting an employee or customer who is a current or former intimate partner.

The statistics are staggering when a perpetrator has access to a gun. Over 4 million American women currently living have been threatened with guns. One million have been shot or shot at.   One in 3 female murder victims and one in 20 male murder victims are killed by intimate partners. Over one-third of women killed by men are killed by intimate partners with guns.  IPV incidents involving guns are 12 times more likely to result in death than incidents involving other weapons or bodily force.  The presence of a gun increases the risk of homicide by 500%. American women are 11 times more likely to be murdered with a gun than in other high-income nations.

Dr. O’Neal’s death is an unfortunate reminder of how IPV impacts black women.  Compared to other racial groups, black women are more likely to experience IPV, have the highest rates of homicide, are killed more often by guns, and are more likely to be killed by someone they know.

As women in white coats, what can we do?  Screen routinely: The US Preventive Services Task Force recommends that women of childbearing age (14 to 46 years old)  be screened for IPV and provided or referred to intervention services when appropriate (screening tools can be found on the CDC website.)  Recognize warning signs in our patients: inconsistent explanation of injuries, delay in seeking treatment, frequent emergency department or urgent visits, missed appointments, late initiation of prenatal care, repeated abortions (from sexual assault and/or not being allowed to use birth control), medication nonadherence (medications have been taken away or not allowed to fill prescriptions), inappropriate affect (jumpy, fearful, cry readily, avoid eye contact, evasive, hostile), overly attentive or verbally abusive partner, social isolation, reluctance to undress or have a genital or rectal examination.

It is just as important that we recognize signs in our family, friends, and colleagues: their partner puts them down in front of other people, they are constantly worried about making their partner angry, they make excuses for their partner’s behavior, their partner is jealous or possessive, they have unexplained marks or injuries, they’ve stopped spending time with friends and family, they are depressed or anxious, or have changes in their personality.

Professional women in an abusive relationship may be reluctant to seek help because of the perception that since they are well-educated, they would not be in an abusive relationship or if they find themselves in an abusive relationship, they have the means to leave.  There is also pressure to maintain the appearance of a stable and happy family.  We have to ensure each other with the safety of seeking helping without shame or embarrassment.

The National Domestic Violence Hotline (thehotline.org) and The National Coalition Against Domestic Violence (ncadv.org) has resources for those in an abusive relationship and those who want to help them.

Danielle Johnson, MD, FAPA is a mother and psychiatrist. She is co-author of “The Chronicles of Women in White Coats.” Follow her on Instagram and Twitter @drdanij.