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Speaking With Care

Gift of Time: Julianne Toohey of UCI Medical Center welcomes babies into the world. Outside of her practice, she teaches other doctors what to look for and how to help grown-ups in peril.


Dr. Julianne Toohey was conducting a usually painless ultrasound examination of a pregnant woman a few months ago when she noticed her patient wince.

After some gentle questioning by Toohey, the woman wept and said her husband had straddled her abdomen and tried to strangle her.

Because the husband was waiting outside the examining room, Toohey said her patient had just minutes to decide whether she wanted the doctor to call the police and change her life forever.

"I told her, 'We can call the police and get you some help. This is your only opportunity.' I was shaking," Toohey recalled.

The patient's husband was arrested in the waiting room.

Until recently, many doctors have looked the other way when they've seen signs of domestic violence. They considered it none of their business.

But Toohey, 40, an obstetrician and gynecologist at UCI Medical Center in Orange, has made spousal abuse her cause. She is encouraging other doctors to do the same by speaking several times a month at Orange County hospitals, medical offices and at medical conferences.

Toohey tells physicians and nurses how to screen patients for domestic violence because "docs are very uneducated in the field of domestic violence, and they don't know that they are," she said.

Recently, she also spoke to 200 police investigators attending a seminar on domestic violence in Irvine. And she was invited by the Orange County district attorney's office to teach police investigators how to work with doctors on domestic violence cases.


Spousal abuse occurs on both sides of the gender line. Because of her specialty in treating women, Toohey sees what happens to women, often pregnant ones.

For the investigators, Toohey spared no ugly detail of blackened eyes and bruised arms. She described the "blunt force patterns" made by belts, fists and bites. "A baseball bat usually leaves two parallel lines," she told them matter-of-factly.

On a large screen, she showed a picture of a woman whose arm bore a massive bruise. "You'll find the same kind of bruise on the other arm because he grabbed her," she said.

Another picture showed a woman's head covered in lacerations. "I tell doctors to go through the scalp very carefully. You can miss huge bumps. It's a great place to hide injuries."

Toohey described burns from flat irons, curling irons, ropes and other everyday objects used as weapons. "The kitchen is a very dangerous place," she said. "One of the worst injuries I've seen was splattering of hot oil on a woman's face."

To police officers, such horrors are nothing new, but many physicians aren't accustomed to that "level of ugliness," Toohey said.

She began her campaign about five years ago after learning that although domestic violence was a widespread problem affecting many patients' health, many doctors knew little about it.

"Domestic violence is the No. 1 cause of injuries to women in the reproductive age group," she said. "As doctors, we study all of these obscure diseases when domestic violence is what we should be worried about. For doctors not to take it on is wrong."

Many physicians would have nothing to do with domestic violence until a couple of years ago, when new state laws required them to report injuries they suspected were caused by domestic violence.

"Mandatory reporting has helped me in many ways, because now docs are asking me to talk about domestic violence all the time," Toohey said. "Before, they didn't think it was their role. Their attitude was 'Just call the social worker.' But [reporting] puts domestic violence in the proper arena. It's a crime we can prosecute."

Some doctors, however, continue to argue that reporting is a violation of their patients' trust and could put patients in greater danger of physical harm, she said.

"They need to be reassured that appropriate steps will be taken [to protect the patient]. We have such improved police intervention that I really feel reporting is worthwhile," she added. "Once a patient is in [an emergency room], you're kind of kidding yourself if you think she's not already in serious danger."

Toohey encourages doctors to notice subtle clues that a patient is being abused, because victims might be too frightened to speak up.

"Often they're ashamed and humiliated to be in [an abusive] situation," she said. "They will deny it, even to the point where they'll say they bit themselves, which is what we saw in our last case."

Among the more subtle signs of abuse:

* Patients will have a variety of vague complaints, such as chronic fatigue, indigestion or sleep and eating disorders, and they'll frequently change their stories about what ails them.

* Sexually transmitted diseases are common because their abusive partner often forbids the use of condoms--or any birth control, for that matter.

* Many patients have injuries in various stages of healing. "I'm not looking for severe injuries; I'm looking for mild, subtle injuries that precede more serious ones," Toohey said.

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