- Doctors and other healthcare professionals have a duty to be alert to signs of domestic abuse.
- Consider your duty of confidentiality.
- The RCGP has detailed advice for GPs.
It is estimated that one in four women and one in six men in the UK will be a victim of domestic violence.
Medical professionals are often in a position to spot the signs, so doctors are reminded to be alert to the possibility of domestic abuse and aware of their duty to safeguard patients and to maintain confidentiality in such cases.
Scenario: part one
A 35-year old patient presents to your GP practice complaining of feeling tired all the time, generalised aches and palpitations. She is tearful and admits to feeling anxious and low.
Your patient says that everything is fine at home but when asking about sources of support, she explains that her husband has stopped her from speaking to her family and friends. She was not able to book a follow-up appointment without first checking with her husband.
While GPs may pick up on signs of possible domestic abuse, patients may be reluctant to volunteer that they are suffering or at risk of harm. It is important to understand that domestic violence and abuse includes controlling or coercive behaviour in an intimate or family relationship.
It's a good idea to offer training to staff on how to explore these issues sensitively with patients and what steps must be taken in response to a disclosure. The RCGP advises that careful records of such consultations need to be made, and that any disclosure should adhere to the practice's information sharing protocols.
The RCGP has issued an adult safeguarding toolkit that includes advice on developing a practice policy for managing cases of domestic abuse. The advice includes:
- electing a named senior person within the practice to identify and engage with local services for victims of domestic abuse
- establishing a care pathway for victims to access these services.
Scenario: part two
One week later, your patient returns to see you and discloses that she has had a positive pregnancy test. She explains that the pregnancy was unplanned and that they have a two-year old at home already.
She admits that when she told her partner about the pregnancy, an argument followed and he pushed her to the ground.
It's well recognised that domestic abuse and child abuse can co-exist. The GMC advises all doctors to be aware of risk factors linked to abuse and neglect. Its guidance, Protecting children and young people: the responsibilities of all doctors (2012) makes it clear that:
- you should know who to contact for advice and this could include your designated professional, lead clinician or an experienced colleague
- you must take action where there is concern that a young person is at risk and do not need to be certain before raising such concerns
- you should seek consent before disclosing information, unless there is a compelling reason not to do so
- there may be circumstances where information should be shared without seeking consent or if consent is refused.
MDU advice to GPs
- Be alert to the possibility of domestic abuse in any patient and make careful records of any concerns.
- Be aware of and follow local and national guidance on the identification and management of patients presenting with signs of possible domestic abuse.
- Make sure your practice has a clear protocol in place for dealing with domestic abuse.
- Liaise with local services who offer support for victims of domestic abuse.
- Consider the family as a whole if abuse is, or may be, present in the household.
- Be mindful of your duty of confidentiality and seek consent for disclosure unless there is a compelling reason not to do so.
- Seek advice if considering disclosure without consent or if consent is refused.
- Record your reasons for disclosing information and whether or not you have consent for disclosure, and document your reasons if you decide not to share information.
We advise doctors to seek advice on individual circumstances from the designated lead for child protection within the surgery or local area team, and from the MDU.
This guidance was correct at publication 30/07/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.