ABSTRACT
Domestic violence is a complex issue at both an individual and public health level. Barriers to disclosure often lie with the doctor rather than the victim. Assessment of risk and devising a safety plan are important steps for the doctor to undertake with the victim. Recommendations for joint counselling or marriage guidance for the couple are usually not appropriate. The efficacy of population screening for domestic violence has not yet been demonstrated. More limited opportunistic screening is recommended, especially in the emergency department, mental health and obstetric settings, and general practice. Health professionals can be a bridge to resources within the community, but this requires knowledge of and liaison with those services.
Subject(s)
Delivery of Health Care , Domestic Violence/prevention & control , Health Policy , Adult , Australia , Female , Humans , Male , Spouse Abuse/prevention & controlABSTRACT
Domestic violence is a common social problem that raises many difficult questions and management issues for both the patient and the doctor. Domestic violence is an abuse of power within the relationship. Physical assault is common and serious, but psychological abuse is more damaging. Perpetrators of domestic violence do not usually perceive that they have a problem and no change in their behaviour is possible unless they want to change. For general practitioners the first step in dealing with domestic violence is detection, and that means acknowledging that it can exist in any patient. General practitioners have three choices in their management of victims of domestic violence: they can do nothing, they can be sympathetic only or they can be an agent of change. Effective management of domestic violence involves raising the victim's self-esteem so that she is able to alter her situation herself.
Subject(s)
Family Practice , Spouse Abuse , Violence , Alcoholism/complications , Diagnosis , Female , Humans , Male , Physician-Patient Relations , Physicians, Family , Spouse Abuse/diagnosisABSTRACT
OBJECTIVE: To discover what measures have been taken in urban Australian hospitals to involve general practitioners (GPs) in public hospital services. DESIGN: A descriptive study. Data were collected by postal survey. SETTING: Hospitals in urban areas. MAIN OUTCOME MEASURES: Appointment of GP affiliates or associates, existence of departments or divisions of general practice, appointed GP liaison positions and formal arrangements for GP shared care and discharge planning. RESULTS: Ninety-five of 102 hospitals (93%) responded to a postal survey. Sixty-five per cent of respondent hospitals had appointed GP affiliates or associates, 32% had a division or department of general practice and 41% had a designated GP liaison position. Forty per cent had formal GP shared care programs and 14% had formal GP involvement in discharge planning. CONCLUSION: There was a high level of adoption of measures to involve GPs in urban hospitals. However, only a minority of hospitals had comprehensive measures in place and sufficient support for this to occur.
