PATIENT WELFARE DOMESTIC ABUSE
Manager Practice
Spotting the signs
Alan Frame looks at an innovative scheme to help healthcare professionals address domestic violence
P
RACTICE managers will know that domestic violence and the signs of physical or psychological abuse in
patients are often hard to detect, and even more difficult to address when suspected. A new initiative has been launched in Scotland with the aim of overcoming some of these obstacles. The Ask, Validate, Document and Refer
(AVDR) programme proposes to equip dentists, doctors, firefighters and even veterinarians and hairdressers to recognise the signs of this crime. The programme will develop and deliver domestic abuse training throughout Scotland, teaching professionals how to look out for the signs of domestic abuse and offer guidance on further support to victims. AVDR was devised jointly by the doctor’s
group, Medics Against Violence (MAV), and the Scottish police Violence Reduction Unit. To date, around 2,000 dentists, doctors, vets, firefighters, hairdressers, dental and medical students have taken part in the programme and new funding means that it can be rolled out across the whole of Scotland, reaching an estimated 100,000 professionals. The scheme was originally developed from an American model by Dr Christine Goodall, a lecturer and consultant in oral surgery at the University of Glasgow and founder of MAV. She began working on the project after many years studying links between facial injuries and violence. MAV have expanded membership to include veterinary surgeons, as a link was identified between animal cruelty and domestic abuse, with hurting
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animals often being used as a means to coerce or punish human victims.
THE FOUR STAGES It is not the intention of this article to provide a tutorial or critique of the AVDR programme itself, but it is perhaps worth taking a few moments to summarise what each of the four stages of AVDR relates to:
• Ask – ask questions of the suspected victim in an empathetic, non- judgmental manner.
• Validate – provide validating messages to the suspected victim.
• Document – note presenting signs and symptoms of abuse in the medical record and any specific disclosures by the victim.
• Refer – refer the suspected victim to appropriate resources and authorities.
Clearly, the first two stages are concerned
with communication, trust and empathy and involve specific skills in which all doctors and other healthcare professionals may benefit from specialised training, such as that provided in this initiative. Stages three and four, however, begin
to raise other medico-legal and ethical considerations which clinicians in particular will have to take on board. By contrast, hairdressers are not bound by professional codes of conduct and a duty of confidentiality to their clients, and in this respect any decision to report or escalate suspicions of domestic violence will largely be taken on individual moral grounds, or to do what “feels right”.
DUTY OF CONFIDENTIALITY It may be worthwhile, therefore, to remind ourselves what considerations need to be taken into account by any healthcare
professional who may be faced with a case of suspected domestic violence. The GMC, for example, make it clear that the doctor-patient relationship is based on openness, trust and good communication, which allows doctors to work in partnership with patients in order that individual needs can be addressed. To fulfil this role the doctor must respect a
patient’s privacy and right to confidentiality. The patient can expect that information about them will be held in confidence by their doctor, which normally means that such information can only be disclosed to a third party with the patient’s express consent. If we look at a scenario where a patient has fully disclosed to her doctor or other healthcare professional that she has been subject to domestic violence but expressly requests that this information is held in confidence, then the dilemma is probably more straight-forward. Unless the doctor considers that what has been disclosed constitutes a “serious crime” or there is real concern about the patient’s or wider public’s safety, then the circumstances should be fully documented and the patient’s right to confidentiality honoured. Suspected abuse of a child within the home would be an exception and should be reported to the appropriate agency. Greater difficulty may arise when the
doctor has suspicions that domestic violence is involved, but the patient is unwilling to confirm or is reticent to provide sufficient details to base a decision on. What to record in the patient’s notes now becomes a dilemma, never mind consideration whether it should be escalated to another authority. This can be a complex area and practice managers are reminded that doctors should seek advice at an early stage from MDDUS.
Alan Frame is a risk adviser at MDDUS AUTUMN 2015 ISSUE 13
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