It’s likely that we come into contact with domestic violence victims everyday – we may just not yet know who they are. It could be the mum who serves in the tuckshop, the young woman who served us at the bakery yesterday, the woman we saw chasing her kids in the park or the elderly lady we saw crossing the road this morning. The raw statistics suggest that one in three women experiences violence. Every day in Queensland there are 180 cases of violence reported to police. Almost every week in Australia a woman is killed by her former or current partner.
Although physical violence can be more obvious, domestic violence can also include sexual abuse, emotional and/or verbal abuse, as well as threatening or controlling behaviour. Often domestic violence victims experience some or all of the different types of abuse.
We unwittingly pass domestic violence victims on the street, completely unaware of the fear they are living in. There are some people, though, that are more likely to have regular contact with domestic violence victims – victims who have yet to confide in someone about their abuse: general practitioners.
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When Wanda Filer was just a few years out of training to be a doctor, she saw a young mother who brought her newborn baby in for a wellness visit. Filer said that she asked the mother lots of good and important questions, except one. It’s what they didn’t discuss that changed Filer’s entire perspective about being a family physician, she said.
Filer said she and the mother talked about breastfeeding and immunization but not about the mother’s physical safety. Filer was not aware that the woman was in an abusive relationship.
Just a few weeks after that visit, the woman was dead. Her husband had killed her, along with her two older children and two relatives. Only the infant survived. Filer hadn’t been taught in residency that homicide is the leading cause of death for women within one year of giving birth. It was more than 20 years ago, and not many physicians had this knowledge.
Filer said she and a colleague, who was the patient’s primary care physician, retraced their steps, wondering what they missed. “I went on a personal journey,” Filer told those who attended the recent panel discussion. “I asked, ‘What could I have done differently?'”
Filer now asks more questions and looks for signs of domestic violence. She now shares her experiences with colleagues who in turn learn from them and they themselves become more aware of the patients’ needs.
Filer says, “I don’t have to sell this anymore, now we have to do something about it. The realization is there.”
Domestic violence victims will be helped directly and indirectly by GP’s digging deeper. An 86-year-old woman thanked Flier when she asked her if she’d ever experienced any physical abuse because it was the first time she had ever been asked that in her long life. One person being more aware can help others become more aware, too.
The Waiting Room For Domestic Violence Victims
Rosie Batty, whose 11 year old was killed by his father in 2014, launched a campaign with the Australian Medical Association last year. It is a campaign focusing on child domestic violence victims. At the launch she told medical professionals that doctors are very much part of helping deal with the family violence epidemic. “One in three of your patients coming through into your medical practice, emergency area, hospital departments, one in three of those women will be affected by violence,” she said. She added that one in four of the children they would deal with would also be affected by domestic violence.
She said that doctors needed the resources to help respond . “How do we respond, do we know how to respond? We may not be able to fix the situation but we need to know the part we can play,” she said. “We need to know how to correctly refer and link our domestic violence victims into the specialised services so their risk assessment is done and their safety is monitored.”
One GP in Australia recently told of an experience that they had. Their reflection on it was this:
Having been a GP for 20 years, I have seen many thousands of patients and faced multiple challenges. I feel I have a battle hardened, robust personality. Recently, however, I had to deal with a situation which touched me emotionally.
After gaining the trust of a patient in a domestic violence situation, the GP heard more and more about the abuse she was suffering. They eventually came to an agreement that when she was ready she would come straight to the practice for help.
A few weeks ago one lunchtime the patient made the decision to escape, she managed to pack a small case and run away from home. In that single moment she left ten abusive years of marriage. She only had one chance at this plan. If she was caught, there may have been terrible consequences for her.
She arrived at my practice crying and very distressed, she had nobody to help her apart from us. She trusted her safety and life with us. We were worried that her family would notice she had left and try to follow and find her.
We put her into a side room far from the main entrance of the practice and she had a cup of tea. As I had rehearsed this very scenario in my mind a few times already, I was fairly well prepared and had the relevant numbers scribbled down.
I quickly liaised with the domestic violence crisis team and the police. The response and support from the agencies was excellent. The patient was lodged in a hotel overnight and the next day she was transferred to a safe refuge.
A toolkit has been developed by the Women’s Legal Service NSW especially for general practitioners. Associate Professor Brian Owler who is president of the AMA says, “One in five women first mention domestic violence to their doctor.” The comprehensive toolkit is very helpful for doctor’s preparing for and helping domestic violence victims. The toolkit is called When she talks to you about the violence and is available here.
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