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Bruising and other physical injuries are the most obvious signs of domestic abuse and often the ones desperately hidden from view.
A newly updated BMA report highlights the need for doctors to take a proactive stance in tackling domestic abuse, which affects one million people in the UK. It also touches upon how pain, fatigue or poor sleep in patients can be the effects of domestic abuse.
Health professionals find it very difficult to ask patients about potential abuse of all kinds, largely due to a lack of training, uncertainty about how to raise the issue and also where to refer them for further support.
The 2011 National Intimate Partner and Sexual Violence Survey, conducted by the National Centre for Injury Prevention and Control in Atlanta, Georgia, highlighted how women and men who suffer abuse can experience a plethora of physical and mental health symptoms.
It found they were more likely to report frequent headaches, chronic pain, difficulty sleeping, activity limitations, and poor physical and mental health than those who did not experience these forms of violence. Women were also more likely to report having asthma, irritable bowel syndrome, and diabetes.
Women are also at greater risk of domestic violence during pregnancy. Physical violence is the second leading cause of trauma during pregnancy after motor vehicle accidents.
Yet while the Royal College of Obstetricians and Gynaecologists recommends all doctors in its specialty routinely ask pregnant women about domestic abuse, this is not the case for all patients across other parts of the NHS.
So, how do you approach the subject with a patient whose history of headaches or chronic fatigue may suggest an underlying cause? Or indeed someone for whom the signs of abuse may be far more obvious?
First you have to be - or appear to be – unshockable. I have spent much of my career as a consultant psychiatrist for people with learning disabilities, who incidentally may also be victims, and or onlookers of domestic violence. I have found that if you look shocked at something they are about to tell you, then they will never tell you the whole story.
People who are victims of domestic abuse often feel it is their fault and are usually very scared. It is vitally important to:
• Give them plenty of time and make sure you do not have to dash off
• Create an open and trusting atmosphere
• See the patient on their own, especially if a partner is insistent about being in the room
• Offer to see them again
Doctors often like to have clear symptoms, a diagnosis and treatment plan, but domestic abuse does not really work like that. With a little extra training and a bit of courage you may find you can treat that unfathomable or treatment resistant symptom after all.
Baroness Hollins is BMA board of science chair
Read the BMA report, Domestic Abuse
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