Courage is contagious: we need to talk about the domestic abuse experienced by female doctors in the NHS

Domestic abuse affects one in four women,1 but little is known about domestic abuse among doctors. As we take strides to tackle inequalities within the NHS, we cannot resolve the problem of gender inequality until we acknowledge how it manifests in the abhorrent form of domestic abuse.

The NHS is one of the largest employers of women in the world.234 Research suggests that healthcare professionals, such as female nurses, are three times more likely to experience domestic abuse than the average person in the United Kingdom.5 A UK 10 year femicide census showed that “healthcare professional” was one of the most common occupations of victims.6

It has been suggested that traits often found in healthcare professionals, such as empathy and compassion, may increase vulnerability to abuse.7 Being “resilient,” as required in medical roles, can result in people tolerating abusive relationships for longer.8 Yet research into domestic abuse among doctors has been largely ignored, which suggests that it remains an uncomfortable, emotive, and highly stigmatised issue.9 When marginalised in this way, the voices of those who experience abuse are silenced.

We must remember this affects our colleagues in all areas of medicine. The façade of those experiencing abuse can be almost impenetrable; only skilled people readers might notice a lapse as the mask momentarily drops. Domestic abuse needs secrecy, silence, and shame to continue. We must do more to provide psychologically safe spaces for our colleagues to seek help.

Firstly, we need to dismantle the false constructs of what a victim of abuse looks like. Domestic abuse is indiscriminate and traverses all people and intersections of society. Stereotypes hinder us from seeing the vulnerability of our colleagues. It also feeds into the shame narrative, whereby doctors experiencing abuse may feel judged, blamed, and “othered.”10

Secondly, we need to understand the barriers doctors face when reporting abuse. Domestic abuse can be extremely destructive to a doctor’s identity and wellbeing. There is anguish in holding two incongruent identities: one where the doctor is the advocate for vulnerable patients and another where the doctor is vulnerable themself.10

Doctors experiencing abuse can face threats of being reported to the General Medical Council (GMC); a strategy used by perpetrators to exert control and yield power. This is a callous attack on a doctor’s identity, which intimidates and discourages them from reporting abuse.10

Complex dynamics can unfold when both victim and perpetrator are doctors, creating further barriers to disclosure.10 The #MeToo moment for surgery highlights how medical hierarchies protect those in positions of power.11 Both the victim and perpetrator might work and live together, which compounds the misery of those experiencing abuse. Employers and colleagues might struggle to navigate these challenging situations. Additionally, the impact of this on patient care needs to be explored further.

These scenarios raise important moral and ethical questions about doctor perpetrators. Perpetrators of domestic abuse bring the profession into disrepute, and there needs to be safer reporting processes for those experiencing abuse. Employers and the GMC should have transparent guidelines for disciplinary processes. We should recognise that not all perpetrators are convicted through criminal courts, but we must remember that they have broken the law and that fundamentally, domestic abuse is a human rights issue.

I believe that tackling domestic abuse of NHS staff needs a multifaceted approach; one that permeates into the fabric of society. We need a coordinated strategy involving key stakeholders such as NHS England, Public Health England, and Health Education England among many others. Further research into this field is needed, exploring the full demographic of victims, including men and the role of intersectionality and workplace inequality.

All NHS organisations should ensure that they have robust domestic abuse policies to protect staff. Education on domestic abuse in staff should be delivered throughout university training and continue into the workplace. The NHS should also allow staff experiencing abuse to access emergency hardship funds where needed. This is particularly relevant in cases of financial abuse or if the victim is a single parent. If we want to safeguard our staff, we must demonstrate our commitment to supporting them in their darkest moments.

Although I advocate strongly for robust domestic abuse policies, these will be redundant if we cannot cultivate an environment of emotional safety for our colleagues. The most powerful tool we have is to give those experiencing abuse a voice and make them feel heard. If we cannot do this, we become complicit in fuelling the secrecy and intensifying the isolation of domestic abuse.

As a survivor of domestic abuse, for me it was the acts of kindness and human connection that helped the most. This was facilitated by a positive workplace culture that made space for these powerful conversations: the colleagues who gave me a voice when I had been silenced for so long, those that noticed, asked, listened, and helped me rebuild when I had become adept at keeping myself quiet and invisible.

I still find it incredibly empowering to share my story, and it amazes me how many inspiring women share their experiences with me. Courage is contagious and we should create a culture within medicine where showing vulnerability is seen for what it truly is: a symbol of strength and a reminder that beneath the shackles of titles, accreditations, and status, what binds us most strongly is our shared humanity.