Violence

November 2011

FocusViolence

Intimate partner violence

Identification and response in general practice

Volume 40, No.11, November 2011 Pages 852-856

Kelsey Hegarty

Lorna O’Doherty

Background

Intimate partner violence is a common problem among women attending general practice, with around one in 10 women currently experiencing physical, sexual or emotional abuse by a partner. Abused women frequently present with physical and psychosocial issues. Yet intimate partner violence often remains concealed and addressing it poses challenges for the clinician and patient alike.

Objective

Although some of the general recommendations in this review may also apply to same-sex relationships and to women who abuse men, this article discusses identifying intimate partner violence in women who present to general practice.

Discussion

Identifying intimate partner violence is important in clinical practice as it underlies many common physical and mental health presentations. Facilitating disclosure and responding effectively requires good communication skills. Safety assessment of women and their families, pinpointing level of readiness to contemplate action, and providing appropriate referral options and ongoing nonjudgmental support are elements of an effective response. General practitioners have the potential to identify women and support them safely on a pathway to recovery, thereby avoiding the long term impacts of intimate partner violence.

Case study

Marilyn is an accountant, 30 years of age, married for 8 years to a construction worker. She presents with low energy and headaches that have affected her for over a year. They have worsened in the past month (since her husband was laid off), affecting her mostly at the end of the day. She has trouble sleeping and reports aches and pains all over. She has been to several other clinics in the past year but has found nothing to be helpful. She has had blood tests, been prescribed painkillers, been advised to get more exercise and change her diet. She desperately needs something to be done for her today as her husband is getting impatient with the lack of results. She is concerned he will become very angry with her when she returns home today. Marilyn’s doctor asks, ‘what happens when your partner becomes angry?’ She has not previously been asked this question and she hesitates. Her doctor says, ‘I would really like to hear what is going on at home’. She bursts into tears and slowly the story of her experience of partner violence unfolds. The doctor assesses her safety and Marilyn indicates she feels she can manage what is happening for now. They make a follow up appointment for ongoing support.

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Correspondence afp@racgp.org.au

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