Domestic Violence: A Handbook for Health Professionals

By Lyn Shipway | Go to book overview

Appendix 6

'Domestic Violence: the General Practitioner's Role': an extract
This extract is reproduced with the permission of the Royal College of General Practitioners from the work of Dr Iona Heath, MRCP, FRCGP
Consider the possibility of domestic violence if:
The possibility of domestic violence should be considered in any of the following situations:
1 Patient admits to past or present abuse.
2 Patient presents with unexplained bruises, whiplash injuries consistent with shaking, areas of erythema consistent with slap injuries, lacerations, burns or multiple injuries in various stages of healing.
3 Patient presents with injuries to areas hidden by clothing (Mehta and Dandrea 1988). Note that it can be very easy not to examine, for example, first generation Asian women properly because of their apparent shyness and because of the sometimes unfamiliar nature of their clothing.
4 Patient presents with injuries to face, chest, breast and abdomen (Stark et al. 1979).
5 Patient presents evidence of sexual abuse.
6 Extent or type of injury is inconsistent with explanation by patient.
7 Substantial delay exists between time of injury and presentation for treatment.
8 Patient describes the alleged 'accident' in hesitant, embarrassed or evasive manner.
9 Review of medical record reveals that patient has presented with repeated 'accidental' injuries.
10 Patient presents repeatedly with physical symptoms for which no explanation can be found (Jaffe et al. 1976). This presentation may be particularly common among women whose first language is not English, and who therefore may find it difficult to express their feelings and suffering (Fenton and Sadiq 1993).
11 Partner accompanies patient, insists on staying close to patient and answers all questions.
12 Patient is pregnant (Mezey and Bewley 1997). Domestic violence often begins with the first pregnancy. Injuries are most commonly to the breasts or abdomen (Lent 1991).
13 Patient has history of miscarriage. Women experiencing domestic violence are 15 times more likely to have suffered a miscarriage (Stark and Flitcraft 1996).
14 History of psychiatric illness, alcohol or drug dependence in patient or partner (Jaffe et al. 1986; Andrews and Brown 1988).

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