Maria (not her real name) is a 42-year-old mother of two children who has seen me repeatedly for multiple medical complaints, the worst of which was severe abdominal pain, nausea, and fatigue, which baffled me and many of her previous providers. Over the 3-year period we met, it wasn’t until I asked her a third time about whether she felt safe at home that she finally felt comfortable enough to share with me that her husband has made her life a living hell. She described being treated like a servant who had no rights. “He controlled the money, the mail, and my activities.” Everything at home had to be just the way he liked it or he would erupt in anger with tirades of verbal threats and occasionally beating her. The bruises he left sometimes could be hidden by makeup. If that didn’t work, she wouldn’t leave the house until they healed.

She had worked for years as a secretary and was highly respected for her work skills, but her last three jobs always ended the same way. She was warned by her supervisor and then fired for continuing to miss days of work, decreased productivity (due to “anxiety”), and repeated disruptive calls to her by her husband. She never told any of her bosses what was happening at home: “It would only make things much worse.”

She finally agreed to call a domestic abuse hotline. With their help she tried a number of options to improve her safety and help remedy the home abuse situation. After two years without improvement, she finally chose to leave her husband. Sadly, she still gets harassing calls and feels that any time now, she could lose her new job. It’s getting harder and harder to find a new employer who will hire her.

One out of four women experience domestic violence; i.e. physical, sexual, or verbal abuse or harassment, isolation, economic control, and other means of coercion. Domestic violence is not an impulse or a substance abuse problem. It is an issue of one partner using power tactics to control the other partner’s life. It can happen to anyone, but happens predominantly to women.

People like Maria are prevented from obtaining help in a number of ways. Maria was reluctant to get help because of her own shame and guilt. “How could I have let this happen to me? To my children?” She always thought no one could or would help her and knew her partner could make good on threats. In her case, how many disruptive phone calls, e-mails, or visits would it take for her to lose her current job? How much more difficult would it have been if Maria’s abusing partner was a co-worker?

In national surveys, 74 percent of domestic violence victims report harassment at work. Work sites know about this problem; 78 percent of human resource personnel report domestic violence as a workplace issue, 94 percent of corporate security personnel rate domestic violence as a high security concern, and 40 percent of senior corporate executives report being personally aware of employees experiencing domestic violence. The consequence to employers has been extensive and expensive; in Maria’s case, employee absenteeism, decreased productivity, increased employee turnover, increased medical expenses that impact insurance rates, and possibly, increased employer security risks and liability.

Just as physicians and other health care providers are improving their training and skills for helping intervention in domestic violence cases, employers must take a stand and do their part to be part of the solution. Employers can grant reasonable and necessary leave from work if an employee needs to attend court, get medical care, or obtain resources in a crisis situation such as safe housing. Employers can develop a relationship with their local domestic abuse project staff who will help to implement employee awareness and supervisor training programs and develop policies to address workplace issues around domestic violence.

Maine Employers Against Domestic Violence (MEADV) is an ongoing initiative to educate employers and business leaders about the impact of domestic violence on workers and employers alike. To their credit, Anthem Blue Cross and Blue Shield of Maine has joined MEADV, partnering with The Maine Coalition to End Domestic Violence and Governor King to take on domestic violence as a high priority issue. Recently Anthem BCBS mailed ten thousand information packets to all of the Maine employers they insure with guidelines for best business practices, safety planning with an abused employee, and community resources available to employers and staff.

I hope to see other corporations and more insurance companies follow suit and join as partners in MEADV. Whether it is the owner of a corner store, the office of a physician or other health care provider, or a major manufacturing facility, we all play a role in reducing the epidemic of domestic violence. Let’s all be part of the solution by using the MEADV packets to develop an effective response to domestic violence. Love should not hurt.

Eric R. Brown, MD, is a member of the faculty at the Eastern Maine Medical Center Family Practice Residency Program.