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At the heart of general practice since 1960

Domestic violence

Dr Priya Joshi gives a round-up of the latest thinking on another key nMRCGP subject

Dr Priya Joshi gives a round-up of the latest thinking on another key nMRCGP subject

Domestic violence, though common, is chronically under-reported. About one-quarter of women experience it in their lifetime. It has more repeat victims than any other crime, and results in the deaths of two women each week and about 30 men every year. Every minute there is one phone call to police about a domestic violence incident in the UK1.

Domestic violence is defined by the Government as 'any incident of threatening behaviour, violence or abuse between adults who are or have been in a relationship together, or between family members, regardless of gender or sexuality'2.

Factors and effects of domestic violence
There are no barriers to domestic violence. It can occur regardless of age, gender, race, sexuality or social class. However, it usually consists of violence by men against women. It is also crucially important to remember that children may be involved and their safety is a concern. There is a link between domestic violence and child abuse.

The effects of domestic violence can be manifold. The victim may suffer from emotional and psychological problems such as anxiety, depression, guilt or low self-esteem. There may be physical manifestations of injury, generally poor health, or even death. Social consequences can include loss of work or income, homelessness and isolation from family or friends.

How to identify possible victims
One must be aware of the possibility and one must deal with the issue rather than assuming that someone else will – you may be the only person to whom the patient presents.

There may be multiple attendances with minor illness, or regular missed appointments. Women may attend with their partner there unnecessarily, who may then dominate the consultation. Repeated presentations with depression or anxiety, or obstetric problems such as recurrent miscarriage or stillbirths should also raise suspicion. Suicide attempts can also be a sign of domestic violence, particularly in women of Asian origin.

Role of the GP
Our role is very important. We need to be aware of the possibility and then act in a non-judgmental and open way with the focus on safety of the victim and any children. At the same time, we should signpost to relevant agencies. We must not guide patients along a particular course of action, as this could lead to a more dangerous situation.

In the practice, posters or information leaflets should be available, with details of relevant agencies such as Women's Aid and Refuge. During the consultation we should be proactive about asking if domestic violence is occurring, and use direct questions. A recent study showed most women were not offended by being asked directly.

However, it is vital to do this when the woman is alone in case the perpetrator, or a close contact of theirs, is present. Safety of any children should be addressed specifically. We should aim for a supportive conversation using sensitive communication skills, so if a victim does not feel ready to discuss things, they may do at a later stage. Accurate note-keeping is essential, particularly of injuries.

Dr Priya Joshi is a GP registrar in Cambridge, nearing the end of her VTS rotation

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