This article may be emotionally distressing and triggering for some readers. Please speak with your therapist, physician or support if you are in distress or local crisis line or the ER.

February: a time when the stores are bursting with pink and red, marketing pitches for gifts and “romantic” dates for your special Valentine.

For many, February is a heavy month, reminding them of the contradiction they have lived or continue living every day. Their romantic relationship is nothing like the couples beaming on the computer screen or the poster by the checkout line.

Intimate partner violence and abuse is a hidden reality for many physicians, yet we have no statistics or information that capture how prevalent and how bad the abuse experienced by physicians in their relationships is.

Physicians have been indoctrinated to present a pleasant put-together façade as part of the professionalism ideal. No matter how much a physician might be in pain, hungry, hurt, sad or struggling — the physician waltzes room to room, patient to patient, attending to the needs of others for hours to days at a time. In the hallways, in the lunchrooms, nursing stations, the chatter usually includes talking glowingly about ones’ family or relationship, upcoming wedding or a trip, and social media: the projection of a perfect relationship continues with shares of the happy couple and family photos.

Unfortunately, just as a thick layer of foundation covers up some big blemishes, physicians’ glowing stories or social media posts can cover up some big “blemishes” in their personal lives, including bruises and marks of physical abuse, let alone emotional or financial abuse.

When we picture a physician, we rarely picture a victim of intimate partner violence. Yet, the two often are one. The public and fellow physicians don’t usually picture a physician, an educated person who has money and privilege, as an abuse victim. Thus, perpetuating the stereotypes of who are abuse victims and perpetuating the shame victims of intimate partner violence bear.

At times when physicians do disclose the abuse they live with to peers, they face judgment, exclusion within their practice group, seen as “unstable” or the one with “issues,” invalidation, suggestions to “work it out” or encouragement to tolerate the abuse rather than divorce or separate for the “children” or to reduce a financial fallout or reputational “damage.”

Being in an abusive relationship can be seen as an inconvenience for the colleagues and the patients should the physician need to have safety plans at work, go into hiding for safety, take time off for various court proceedings in a family court or be emotionally impacted by the abusive partner and be more dysregulated at work.

At worst, someone may report this physician (who is trying to survive potentially a life-threatening abusive relationship) to the hospital or the board for their tearfulness or perceived “instability.”

Other colleagues may gossip, “How could she/he not have known?”

Physicians in abusive relationships often languish in fear, obligation and shame — afraid of being judged, dismissed, reported, invalidated, losing their job, their children and the career that they gave up 10-15 years training for and their safety from the ex-partner.

The constant contradiction between their professional life and façade and the hell of the abusive relationship is crazy-making. One minute the abused physician is caring for patients, running the ER department, teaching residents, headlining hospital meetings, giving expert opinions; the next minute, they are abused, beaten, called names, threatened and financially robbed.

Physicians might be abused physically, sexually, emotionally and financially by their partners. And as for the general population, the risk of violence and death increases during pregnancy for women and when a partner tries to leave an abusive relationship.

Physicians may struggle to seek help for physical injuries when assaulted as they may be working in the same hospital, ER department, crisis services or with police that would have to be called to investigate.

Physicians also may believe their partners will change or internalize the guilt for abuse due to physician’s long work hours or be very dependent on the abusive partner for childcare or social support if they are isolated from other supports or come from a different country.

Abuse often does not stop when a physician leaves the relationship and can continue indefinitely.

Unfounded accusations by the ex-partner to the regulatory college/board, complaints to employers, dragged-out court proceedings for divorce/family court/financial settlement that force the physician to overspend on legal costs or deal with the time drain of the legal processes while already limited on time, intentional defaulting on any joint loans or financial obligation, calling the police on the physician ex-partner who show up at the medical office or physicians’ house, alleging unfounded substance use to the employer or CPS for the shared children could also be part of ongoing abuse post-breakup.

Reputational damage is immense for the physician within the community should the ex-partner engage in cyberbullying and various accusations about the physician’s character, parenting or even physician abilities or mental health stability. Abuse often continues if there are shared pets or children — especially when an abusive ex-partner uses the child to create ongoing chaos, threats, allegations toward the physician parent or alienates the child from the physician parent or continuously puts down the physician ex-partner in front of the child.

Abuse in physician relationships is real but hidden and can be deadly. Intimate partner violence can happen to any one of us or the learners around us. We have to acknowledge the hidden reality many physicians have lived, survived, continue living and died from.

We shall never forget the picture-perfect social media posts of Dr. Elana Fric, an accomplished family doctor, a mother and a leader who died at the hands of her neurosurgeon husband with her murder details captured on his licensing page. We can’t forget the death of Dr. Tamara O’Neal, an emergency physician, who was shot dead by her ex-fiance in 2018 in the parking lot of the hospital she worked at.

We shall never forget Dr. Sarah Hawley, a University of Utah family medicine resident, was shot dead by her boyfriend in muder-suicide in 2019 .

We shall never forget little Keira, who died while with her father who was engaged in a family court process with Keira’s mother, Dr. Jennifer Kagan.

As we scroll past alluring romantic posters, as we do every February and throughout the year, remember that for many physicians, those posters are a painful reminder of the love-bombing, the shattered promises and dreams, the façade of their social media postings and hallway chatter while they cover up the bruises, the threats and daily abusive reality some of us cannot even fathom happening just right next to us.

Maryna Mammoliti is a psychiatrist.

Image credit: Shutterstock.com