Approximately 1 in 6 women experience physical or sexual violence by their current or previous partner, and primary care is the first point of contact for 1 in 5 women initially disclosing domestic violence. Therefore, the primary care practitioner needs to be able to recognise the signs of domestic violence, feel confident asking about it, and provide appropriate support and signpost to other services.
Being aware of and identifying signs of potential domestic violence is the first step. Physical signs of violence may include unexplained injuries such as bruises, abrasions or burns. Behavioural changes may include increased attendance at primary care, multiple cancelled appointments, or an inability to articulate the reason for attendance. Signs during a consultation may include heightened anxiety, hypervigilance, or low mood. There may be indicators of other types of abuse, such as sexual, emotional, or financial abuse.
Even where signs are absent, the primary care practitioner should routinely ask about domestic violence, ensuring there is an opportunity for women to speak with the primary care practitioner alone. Research has shown that simply asking about violence facilitated disclosure in many cases. Many women are reluctant to disclose domestic violence due to fear, so it is important to ask in a non-judgemental and compassionate manner. If the woman does not disclose any violence, her right to privacy should be respected.
Where physical signs are spotted, it is important to ask the woman specifically about these signs. If a woman does disclose domestic violence, it is most important to listen without judgement and provide validation that abuse or violence is not her fault. Women may need time to talk about their situation, and it may be beneficial to arrange a follow-up appointment. Any immediate medical needs, such as wound care or evaluation of injuries in secondary care, should be addressed, and examination findings should be carefully documented within medical records.
It is important to ask about the family circumstances to ascertain if there are other members of the household at risk of violence - for example, children. A referral to community services is essential when there is reason to suspect that children are at risk of significant harm. Address any other issues, such as alcohol or drug dependence, as these may be used as coping strategies.
Knowing about specialised services such as 1800RESPECT, a national helpline providing confidential support and information, is helpful. Many women do not wish to report the perpetrator of violence and do not immediately wish to leave the situation. However, women should be aware of the legal support available should they want to involve the police. Organisations such as Women's Legal Service Australia offer free legal advice and support to women experiencing domestic violence.
Collaborating with the women to form a safety plan might also be beneficial. This plan may include identifying a safe place to go, packing a bag with essentials, or establishing a safe word to use with trusted friends or family to indicate immediate danger.
Identification and management of women disclosing domestic violence is challenging, and the primary care practitioner can play a key role in overcoming barriers to disclosure.
Dr Samantha Miller, MBChB
Learn more about this topic in the HealthCert online Foundation Certificate of Domestic Abuse & Violence
Read another article like this one: Routine health checks GPs should conduct with female patients
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