Helping victims of sexual assault
Dr Helen Mills describes her role as a forensic physician and a GP
Dr Helen Mills
Role Forensic physician and salaried GP
Place of work St Mary’s Sexual Assault Referral Centre, Manchester
Hours worked per week 15 hours as a forensic physician, 20 hours as a GP
I get my usual early morning wake-up call from my lively three-year-old. I drop him at nursery before heading to work at the sexual assault referral centre. I’m a GP for most of the week, but I work as a forensic physician there one day a week and sometimes do weekend or night shifts.
I arrive at the centre and discuss pending cases with our admin team and over the phone with a duty officer from Greater Manchester police, who give us most of our acute cases. My role involves examining complainants of sexual assault, either as part of a police investigation, on behalf of social services, or for clients who have referred themselves with no police involvement. I act as both an independent medical witness and a doctor - I conduct forensic examinations on patients as well as treating their health.
I begin the morning meeting with my team of 10, which includes independent sexual violence advisers (ISVAs), counsellors, doctors, admin staff, child advocates, a manager and a clinical director.
We review two cases that came in from the overnight team, which I’m often part of. I also do on-call but last night I was writing a statement for the police - the medical evidence has been requested for a previous client’s court case.
My first client arrives - a 46-year-old man who alleges he was anally raped yesterday by someone he regarded as a friend. Our crisis worker puts him at ease while the police officer gives me the details of the alleged crime. We can examine clients outside the centre when travel is impractical, such as in nursing homes, an intensive therapy unit or prison, but we prefer to use the centre to maximise evidence-gathering ability and forensic integrity.
The man is in tears, admitting apologetically that he drank alcohol before coming in. I assure him that part of our role is to support him, discussing our follow-on services, which include counselling and being supported by ISVAs. I do a capacity assessment on him to check he can consent satisfactorily for the medical and forensic examination - as he has been referred to us by the police, this involves his agreeing to our passing on our findings to them or criminal justice system.
I take his medical history and recap what the officer has told me, which the man confirms while holding his head in his hands. We discuss his concerns about sexually transmitted infections and after a risk assessment I advise him to start HIV and hepatitis B post-exposure prophylaxis, which reduces the risk of the viruses becoming established. I arrange a follow-up with GUM.
The patient says he is worried about the examination, so I reassure him that he is in control and we can stop at any point. I map his injuries on body charts. These include bruises on his wrists and back. He tells me they are from being held down by his assailant.
I perform an ano-genital examination and take samples for DNA analysis using a proctoscope for internal swabs. I label the samples and complete the paperwork for the chain of custody. I hand them over to the police with a summary of findings to help them prior to my full statement.
Our clients are all vulnerable in some way, not necessarily just because they are attending the centre. Some have issues with alcohol or drug misuse. or mental health and learning needs. My next client, a 14-year-old-girl who this morning reported a digital vaginal penetration by a fellow resident at her children’s home, arrives with her social worker. She wants to be reassured that she will have no long-lasting injuries, and I’m pleased that I’m able to do that.
I head home, collecting my son from nursery on the way. I’m glad I was able to leave on time; it’s rarely a nine-to-five job (and the nursery fines parents who arrive late). After tea, I bathe my little one and put him to bed, before mentally running through my day. The work is tough, but I wouldn’t change it for anything. I’m lucky to be part of a team that strives to make a difference and frequently succeeds.