‘As a GP, I could spot signs of domestic abuse in patients – but not in myself’

On the first NHS Domestic Abuse Awareness Day, one GP breaks the silence about coercive control and the lasting effects it had on her identity, safety and career

In 2019, my 10-year relationship with the father of my children ended. I was faced with a seismic reckoning that shattered the sense of reality I had created for myself. My solicitor pointed out behaviours that indicated I was in a coercively controlling and abusive relationship. I thought: ‘How could I have been so blind?’

More than one in five people in England and Wales have experienced domestic abuse. Rates are especially high among female healthcare professionals, with research suggesting that they are three times more likely to experience it than the average person in the UK. A 2018 femicide report based on data taken from a decade-long period revealed that ‘healthcare professional’ was one of the most common occupations amongst victims.

This reality is rarely spoken about openly in medicine, which is one of the reasons I feel compelled to share my story. With the launch of the first NHS Domestic Abuse Awareness Day, it feels more important than ever to add my voice.

After my conversation with my solicitor, and with my rational medic’s brain in full gear, I embarked on a journey of learning about domestic abuse and the science of trauma. I went on courses, read books and listened to podcasts. I worried that I was so lacking in knowledge, that I may have missed this in my patients.

In 2021, the Domestic Abuse Act introduced reform in the UK, creating a clear statutory definition of domestic abuse. This strengthened protections for victim-survivors, but in my opinion, did not coincide with adequate education across healthcare about the nature of the coercive and controlling behaviour that commonly underlies domestic abuse.

Even though the behaviours of domestic abuse were recognisable to me, reconciling these with my own lived experience was challenging to accept. Over time, the controlling and manipulative behaviours, which induced fear, shame, guilt and self-blame had left me feeling numb and detached from my emotions. My sense of self and self-worth had eroded over time. Denial and dissociation had become strong protective mechanisms, so slowly and insidiously that I did not even see it happening.

Working as a GP, I am faced daily with human suffering. We are all taught to detach and rely on professional objectivity, sometimes ignoring the emotional landscape of the patient sitting in front of us. Attuning to this can sometimes feel like too much to bear. Sensitivity can be seen as a weakness – one to be hidden in workplace cultures that prioritise efficiency and enforced stoicism. We all rely on cognitive shortcuts to make quick decisions, but we do have responsibility to examine our own biases and stereotypes to optimise our rational thinking. In hindsight, my own stereotypes about perpetrators and victims of abuse impaired my ability to see that this was happening to me.

Many of my workplace cultures have also been toxic; with abuse of power normalised, and sexism/misogyny rife from medical school through to my GP partnership. Exposure to the impact of violence is high, which resulted in me minimising my own suffering when compared to the profound suffering of my most vulnerable and marginalised patients.

The traits I once valued in myself, such as compassion, sensitivity and being a good listener had been used against me and redefined as being ‘weak’, ‘caring too much’ and being ‘too emotional’. My boundaries had become weakened through constant battering both at home and at work, and I had developed people-pleasing and conflict avoidant tendencies. In hindsight, this was also self-preservation designed to protect me from the trauma I was experiencing daily. How many of us in medicine have these tendencies?

It was a truly isolating experience. I tried to hide my distress from my children, family and friends. I did not want to burden them. I withdrew. I felt attacked by the passing comments of people that were perceived as victim-blaming and judgmental, even if not personal to me. Many of the social and cultural norms that I once accepted as ordinary revealed themselves as mechanisms of inequality.

I felt traumatised and at times unsafe. I engaged in talking therapy and EMDR, I read self-help books on healing from abuse and I prioritized self-care. I tried to do all the right things, but I soon recognised that healing is profoundly challenging in the NHS as it currently is. Re-traumatisation became an everyday hazard and policies and commissioning limitations formed barriers to accessing the help I needed with my mental health. I experienced moral injury from being able to afford excellent private therapy, when I knew many of my patients did not have this luxury. I experienced institutional betrayal when I attempted to speak out about poor treatment towards me in my workplace, that was exacerbating my distress, but felt disbelieved.

I was open at work to try and elicit support and understanding, but felt disillusioned by the dismissive responses and poor confidentiality. Although my workplace had a safeguarding policy on workers with domestic abuse, at no point was this applied to me. I assume people felt I was immune to the need for safeguarding considerations as a GP, or perhaps it made them feel uncomfortable and they did not feel equipped to address this. It felt dehumanising.

I alone knew my vulnerabilities ran deep. I had grown up with experiences of abuse and trauma. I believe people are often drawn towards caring professions for a reason. Adverse childhood experiences are common across all of society and a powerful driver of behaviour and chosen life paths. My openness with colleagues led to more disclosures and I developed a heightened awareness that I was not alone when it came to being a healthcare professional with a personal history of domestic abuse. This experience was common and often hidden. I also developed a heightened awareness of trauma in my patients, along with recognition of the often profound impact on their health and wellbeing.

The statistics do not lie – trauma is common. According to the WHO, nearly a third of women worldwide have experienced sexual violence at least once in their lives. I developed a growing awareness of the strong need for trauma-informed care in healthcare to support both staff and patients, which is very slowly being recognised across all public sector services. Survivors of trauma often face long-term health consequences, whilst the traumatic experience is often overlooked.

Several years on I am still healing. Although my life is much more stable, I am still affected by what happened to me and I still utilise the techniques and skills I learnt in therapy to help me manage my day-to-day life. My eyes are open to the trauma around me, both in patients and my professional colleagues. I find it challenging to work within a healthcare system that focuses on symptom recognition and diagnosis to provide evidenced-based care, but can risk overlooking the relevance of traumatic experiences and human suffering in presentations to healthcare professionals. Could our treatment of patients be enhanced by also applying a trauma lens alongside our current models of care? I personally believe this could be beneficial.

I feel that now, more than ever, the community of medicine needs to listen to the collective voices of lived experience and use these powerful voices to re-imagine our culture and practices in order to better serve our colleagues and patients. I hope that the future brings more awareness within the NHS of the nature of domestic abuse, alongside more compassionate, inclusive and trauma-informed systems and workplaces.

The author is a GP in the North of England

The first NHS Domestic Abuse Awareness Day was launched by the Doctors’ Association UK and Medical Women’s Federation, to urgently highlight the need to recognise and respond to domestic abuse affecting NHS staff, and recognise the unique barriers they can face seeking help.