BMJ  2004;328:618 (13 March), doi:10.1136/bmj.38014.627535.0B (published 6 February 2004)

Primary care

General practitioner management of intimate partner abuse and the whole family: qualitative study

¹ Centre for the Study of Mothers' and Children's Health, La Trobe University, 251 Faraday Street, Carlton, Vic 3053, Australia, ² National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 0200, Australia, ³ School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora, Vic 3086, Australia

Objective To explore management by general practitioners of victimised female patients, male partners who abuse, and children in the family.

Design Triangulated qualitative study comparing doctors' reported management with current recommendations in the literature.

Participants 28 general practitioners attending continuing medical education about management of domestic violence.

Results Doctors perceived partner abuse in diverse ways. Their gender, perceptions, and attitudes could all affect identification and management of this difficult problem. A few doctors practised in recommended ways, but many showed stress and aversion, difficulties in resolving the tensions involved in managing all family members, and neglect of the risks to children. Some doctors used contraindicated practices, such as breaking confidentiality and undertaking or referring for couple counselling. Doctors who were not familiar with community based agencies were reluctant to use them. A lack of expertise and support could have a negative impact on doctors themselves.

Conclusions General practitioners managing partner abuse need to be more familiar with and apply the central principles of confidentiality and safety of women and children. Recommended guidelines for managing the whole family should be developed. Doctors should consider referring one partner elsewhere and avoid couple counselling; always ask about and act on the children's welfare; refer to specialist family violence agencies; and seek training, supervision, and support for the inherent stress. Medical education and administration should ensure comprehensive training and support for doctors undertaking this difficult work.

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• Miller, D., Jaye, C. (2007). GPs' perception of their role in the identification and management of family violence. Fam Pract 24: 95-101 [Abstract] [Full text]  
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