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Going the extra mile for the most vulnerable

Dorothy was in her 80s and with stoicism of her generation, she rarely called and bore her health problems quietly. When her visit requests became more frequent and her symptoms escalated, it took me a while to realise that she was, in fact, anxious and depressed. One day her husband left as I arrived and she told me her story.

We should not punish the most vulnerable for the failings of our system

Life had been hard – four children and little money. Her husband had started to beat her when she was first pregnant and it had continued until they had all grown up. She told me how she would walk out to the shops bruised and battered. ‘No-one would say a word,’ she said, ‘they just looked away.’ When she was badly injured she went to her GP and told him what had happened. She asked for help and he arranged for X-rays and dressings and told her to be more careful in future: ‘Try not to rile him up,’ he said.

So she went home defeated, knowing there was no help to be had. And as her children grew up the violence receded leaving just words: anger, put-downs, criticism and control. She never thought of leaving and had nowhere to go. Only one daughter overcame her fear and loathing to stay in touch.

But now he was getting forgetful and confused and frustrated. The shouting started again and sometimes he raised his fist and she knew that before long he would hit her. She was afraid again.

It still wasn’t easy to help her. But things had changed so much. We believed her and knew that she needed protection. The local dementia team stepped in. She had counselling and support and his capacity was assessed. In the end he needed admission to a specialist nursing home and at last she was free of him.

We now actively help patients like Dorothy as a ‘domestic violence aware practice’ seeking out the signs of domestic violence and abuse. So when women and children come to us in crisis we are quick to refer for support and to supply a letter confirming their situation so they can access legal aid.

Recently, on a GP Facebook forum there was a heated discussion about providing these letters. Hard-pressed GPs, frustrated by unfunded demands for letters and reports, wanted to add this to the list of requests we should say no to, like ‘fit to bungee jump’ certificates for charity events. I raised my voice to say we should not punish the most vulnerable for the failings of our system. For these women, legal aid is a lifeline, their only chance of leaving abusive relationships and keeping custody of their children. What is the point of our own resilience if we can’t help others find theirs, if we turn our backs as Dorothy’s GP had all those years ago?

Many victims still won’t cry for help. When they do, we may sometimes need to go the extra mile.

Dr Helen Mutch is a GP partner in south Bristol

Other writing competition entries

(Winner) Dr Renee Hoenderkamp: ‘I knew I was breaking every rule’ 

(2nd place) Dr Helen Cotton: My son’s call for help saved me

(3rd place) Dr Richard Cook: ‘I tried to speak, but no words came’

(Under-35s winner) Dr Heather Ryan: Sometimes you need to break rules to be kind

(Runner-Up) Dr Celine Inglis: ‘Being a doctor puts you in a strange position for tragedy’

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