1 / 29

Domestic violence and abuse: Responding as a doctor

Domestic violence and abuse: Responding as a doctor. Dr Rae Adams. 2/9/19. UK definition. Between intimate partners/ex/family C oercive, threatening, violent or abusive Men or women , regardless of sexuality Physical, sexual, emotional, financial, psychological. Why this topic?.

west
Download Presentation

Domestic violence and abuse: Responding as a doctor

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Domestic violence and abuse:Responding as a doctor Dr Rae Adams 2/9/19

  2. UK definition • Between intimate partners/ex/family • Coercive, threatening, violent or abusive • Men or women , regardless of sexuality • Physical, sexual, emotional, financial, psychological

  3. Why this topic? • Common, relevant, hidden, and difficult • Globally – 1 in 3 (lifetime) • Pregnant women 1 in 10 (current) • Us

  4. Why doctors? • Clinical responsibility • Legal responsibility • Moral responsibility

  5. Illness, violence and abuse Mental illness Substance abuse Chronic pain Miscarriage Preterm delivery APH IUD (16 in 1000 pregnancies) STIs TOPs (recurrent, hidden) Fear/pain on VE Low smear rates

  6. Your role to protect children • Witnessing abuse is child abuse • Worse health and social outcomes of ALL types • Safeguarding is your personal duty • Supporting a mother will support her children

  7. UK interventions • 24/7 helpline • Refuges and safehouses • Sexual assault referral centres • Advocates

  8. Independent Domestic ViolenceAdvocates (IDVA) Help with decision-making and safety planning Support for police interviews or court proceedings Always there for their client

  9. So what can you do? ASK THE QUESTION ASK THE QUESTION MAINTAIN SAFETY REFER REFER RESPOND WITH EMPATHY RESPOND WITH EMPATHY DOCUMENT DOCUMENT

  10. Challenges faced by doctors I haven’t got time I What if I cause harm? I haven’t had training Other people will do it… Nothing works… its hopeless

  11. What happens when you feel hopeless? Domestic violence patients are difficult patients

  12. Drug seeking….time wasting...drain on resources Mental illness Substance abuse Chronic pain “Lazy… non- compliant” Miscarriage Preterm delivery APH IUD (16 in 1000 pregnancies) STIs TOPs (recurrent, hidden) Fear/pain on VE Low smear rates Selfish...out of control”

  13. It’s impossible!! ASK THE QUESTION ASK THE QUESTION MAINTAIN SAFETY REFER REFER RESPOND WITH EMPATHY RESPOND WITH EMPATHY DOCUMENT DOCUMENT

  14. Case study: Patient A Patient A: Primip 26+5 with a small volume APH, spontaneously resolving. Anti D given. Background of PTSD. Presented with partner. Social work report on file- high risk violence.

  15. 1. Ask the question • Ask everyone in ‘high prevalence environment’ • Can it be linked to clinical presentation? • Explain reason for enquiry (we can help!) • Memory aid = HARK • = HURT ….AFRAID….RAPED...KICKED

  16. 2. Maintain safety • Only ever ask when patient is alone- • Routinely see alone • Show her to the bathrooms • Move to different room for scan or examination • Await admission to ask • Don’t pressurise victim to end the relationship • Violence and risk of murder escalates once she leaves • Ask her to consider her safety

  17. What happened next? Patient A: Seen and examined without partner... Absolutely denied violence or abuse. Told her partner we had asked about violence...very risky Follow up plan: maximise her support so she has more CHOICE and CONFIDENCE (mental health team, community midwife) Document professional concern, discuss with safeguarding

  18. Was she a difficult patient? • Denied the violence ….lying?? • Seemed upset and offended that I’d asked • Told her partner- put us both in potentially dangerous position • Just asking the questions does some good • Research suggests most women WANT doctors to ask • Sometimes demonstrating loyalty to a perpetrator is the safest thing a victim can do

  19. Case study: Patient B 25yr old P1 Admitted with pain, fever, discharge- TOA on scan. Angry and uncooperative on the ward...then made distressing disclosure of domestic violence. ….very angry when asked about her other child “how dare you accuse me of harming my children!!” Stormed out of ward...

  20. 3. Listen with empathy • Stop what you’re doing • Emphasise key messages- same for everyone • You are safe here.  • It is not your fault • There are things we can do to help • I’m glad you told me 

  21. 4. Refer For the patient: • National DVA helpline • (Admit for safety)  • Contact the domestic violence team/IDVA • Other services they require e.g. mental health, housing support For the whole family: • Make a safeguarding referral/ Call the on call social worker • (names and DOB of children) 

  22. 5. Document • Document denial of abuse as well • Alert future professionals e.g. GP, midwife • Don’t use handheld notes • The woman can use good documentation as evidence in court

  23. What happened next- Patient B? Patient B: Safeguarding referral - ensured child was safe Letter to GP - sharing concerns Offered open follow up, non-judgemental Patient B came back in to thank us for her care- had successfully got an injunction against her partner, had a support worker.

  24. Was she a difficult patient • Conflict and aggression • Absconded from care and ‘bouncing back’ • Reacted badly to safeguarding enquiries...not putting her children first? • Disclosures and intimate examinations can be retraumatising • Absconding - may represent loss of control over private life • Returning = patient testing and checking whether hospital is safe • 3/4 of women endure personal injury for years, but take the risky step to end violent relationships to protect their children

  25. What happened next- Patient A? Patient A: Continued to deny alleged assault. Engaged well with mental health teams, PTSD symptoms improved In confidential notes safeguarding nurse wrote: This case will remain HIGH RISK and police will stay on high alert on the basis of my professional judgement. “ Patient returned several times throughout pregnancy- always denying abuse. Healthy mum and baby, safeguarding plan at delivery.

  26. Summary ASK THE QUESTION ASK THE QUESTION MAINTAIN SAFETY REFER REFER RESPOND WITH EMPATHY RESPOND WITH EMPATHY DOCUMENT DOCUMENT

  27. Thank you

  28. Resources http://healthtalk.org/peoples-experiences/domestic-violence-abuse/womens-experiences-domestic-violence-and-abuse/what-doctors-need-know-about-domestic-violence-and-abuse

  29. Resources Information leaflet for patients: Home Office and Southall Black Sisters: Three steps to escaping domestic violence available at https://www.gov.uk/government/publications/three-steps-to-escaping-domestic-violence Overview of best practice for doctors: Safe Lives, RCGP and IRIS: Responding to domestic abuse: Guidance for general practices available at http://www.safelives.org.uk/sites/default/files/resources/SafeLives_GP_guidance_manual_STG1_editable_0.pdf NICE Guidelines https://www.nice.org.uk/guidance/ph50 Department of Health (2017) guidelines Domestic abuse: a resource for health professionals https://www.gov.uk/government/publications/domestic-abuse-a-resource-for-health-professionals CAADA-DASH Risk assessment: http://www.safelives.org.uk/sites/default/files/resources/Dash%20risk%20checklist%20quick%20start%20guidance%20FINAL.pdf

More Related