Managing the effects of abuse and violence on our patients can be a rewarding aspect of general practice, however, it can be stressful. If GPs feel empowered, then that empowerment can positively enhance the doctor–patient interaction. Factors that may contribute to this enhancement are ongoing training, clearly delineated practice policies, case management supervision, peer support, clear doctor–patient boundaries and a developed network of resources and referrals.
As well as the usual stresses associated with difficult and time-consuming clinical encounters, there are factors that are important for GPs to address when working with patients who have experienced abuse or are currently being abused. The trauma that these patients have experienced constantly challenges our individual limits and drains personal resources.319 GPs often face professional isolation, ambiguous success, unreciprocated giving and failure to live up to our own expectations for ensuring positive change.320 Dealing with these issues is important, not just for the health of the GP, but also so that we can maintain as objective a stance as possible to facilitate a successful outcome for the patient, and maintain good relationships with the patient’s family, friends and community.
Vicarious traumatisation is the inner transformation of the care givers experience as ‘a result of empathic engagement with victims, clients and their trauma material’.321 It can ‘encompass changes in frame of reference, identity, sense of safety, ability to trust, self-esteem, intimacy and a sense of control’.322 This is a particular danger when dealing with those who are, or have, experienced abuse and violence. GPs who have a similar background to the community they serve are at a higher risk of vicarious trauma. This may include GPs of Aboriginal and Torres Strait Islander descent, those who were refugees and many international medical graduates (IMGs). These situations will be particularly difficult for GPs who have personally experienced abuse or have experience abuse in their families.
It is important to maintain an environment in which there is adequate protection from burnout or the vicarious trauma that may come from hearing the stories of patients involved in abuse and violence. The medical profession has a ‘long and admirable, but often unhealthy, tradition of self-sacrifice to work’.316 Those who work in this field need to be vigilant about ways to overcome compassion fatigue, renew the joy in practice, create life balance,317 and adequately care for their own physical, mental, emotional and spiritual health.
A rural perspective
GPs who work in rural areas are at a higher risk of problems with stress, burnout and vicarious trauma. They are highly likely to find it difficult to access locums, peer support and ongoing training, and usually have more after-hours work, are more isolated and find it more difficult to maintain clear boundaries between themselves and their patients.316