پزشکان عمومی و مدیریت خشونت خانگی: نتایج یک مطالعه کیفی در آلمان

A qualitative interview based study on ways of addressing and managing domestic violence (DV) by general practitioners (GPs) is presented. Problem centred semi-structured topic-guided interviews were conducted with 10 male and nine female GPs. Transcribed passages were analysed with the deductive approach of qualitative content analysis. Female doctors gave broader definitions of DV. Addressing of DV by a patient was perceived as a demand to act by all doctors. Documentation of injuries was considered to be important. Time constraints, feelings of being ashamed and helpless were described as barriers in addressing DV. Female doctors reported being anxious about losing their professional distance in cases of female victims. While female participants tend to take an ‘acting’ role in managing cases of DV by being responsible for treatment and finding a solution in collaboration with the patient, male doctors preferred an ‘organising’ role, assisting patients finding further help. Definitions of DV and differences in addressing the issue seemed to be strongly affected by personal professional experience. Definitions of DV, personal barriers in addressing the subject and understanding of the own role in management and treatment of DV cases differed between male and female doctors. Pre-existing definitions of DV, personal experience and gender aspects have to be taken into account when planning educational programmes for GPs on the issue of DV.

Clinical forensic medicine and examination of surviving victims of violence has become a growing field in forensic medicine. Nevertheless, only a portion of cases is examined by forensic specialists.1 In order to foster everyday patient care quality for victims of violence, training of general practitioners (GP) on managing common forms of violence, especially domestic violence (DV), is an important issue that forensic specialists should be involved in to share their competencies and experiences. DV is a major public health problem. It has been shown, that 41% of women waiting to see their GP have experienced physical violence from a partner or former partner, 17% within the past year.2 As DV can be causative or co-causative for a variety of health problems leading to consultation of a GP (e.g. injury, chronic pain, gastrointestinal and gynaecological conditions, depression, post-traumatic stress disorder and alcohol and drug abuse), understanding about DV and strategies for counselling and taking care of these patients are pivotal. This is not only of importance for patient care quality. Besides medical examination, information and treatment, the majority of abused women value empowerment and empathy through their physicians the most. This is of great importance for promoting disclosure of DV and initiating change.3 Otherwise shame and fear of retaliation might avert disclosure, especially as not all patients are aware of the relationship between DV and physical symptoms.4 On the other hand, the physicians' feeling of incapacity and powerlessness concerning the domestic situation can be barriers for assisting and supporting the victims.5 A comprehensive training programme for GPs can have positive effects on the physicians' awareness, knowledge, case management and general confidence in addressing the subject.6 However, trainees can have different professional experiences and beliefs about dealing with victims of DV: While some physicians believe that a more passive role would be appropriate (preventing unnecessary pressure), others emphasise that an active and promoting way of counselling is necessary to manage the problem. In addition, there appear to be gender differences among physicians. While female doctors believe DV to be a more serious health-care issue than their male counterparts and training seems to have a greater effect in women concerning the detection of abuse cases, male physicians appear to have a greater level of confidence in their abilities concerning the case management of DV.6, 7 and 8 The purpose of this study is to identify differences in addressing and managing cases of DV by GPs using a qualitative approach.