Intended for healthcare professionals

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Primary Care

Should health professionals screen women for domestic violence? Systematic review

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7359.314 (Published 10 August 2002) Cite this as: BMJ 2002;325:314

Rapid Response:

Re: Public or private matter?

Peter Davies wonders if it might be in the interests of the community
at large for doctors to violate confidentiality in order to report cases
of domestic violence to the police. My concern is that violation of
confidentiality in such cases might well have a detrimental effect
overall.

Surely, if victims of domestic violence know that they may not have a
say in whether or not their doctors report the matter to the police, this
may make them more unwilling to present to the doctor at all? Victims who
don't feel willing or ready to make their abuse a police matter may then
feel unable to seek physical treatment for their injuries, and may also be
deprived of any chance to get emotional support and/or practical advice
from their doctor.

Apart from this obvious practical problem, I am also concerned about
the possibility of more subtle adverse effects. The emotional toll of
abuse on a victim's self-confidence and sense of self is frequently far
more devastating, in the long term, than the physical injuries. Allowing
a victim no say in whether his or her situation is reported to the police
may well solve the immediate physical problem of the abuse, at least in
the short term. However, I wonder whether such an approach might also
demean the victim's self-confidence still further, by the well-meant but
potentially rather insulting assumption that he or she cannot make a
crucial life decision for him- or herself.

In extremely severe cases where there seems a serious risk of the
victim's imminent death or grave injury, getting the person out of
physical danger by hook or by crook might well take precedence over such
considerations. However, most cases are of lesser physical - though no
less emotional - severity. In such cases, would the better approach be to
concentrate on encouraging them to report the crime themselves and
providing support while they do so? Is it possible that such an approach
might be more psychologically helpful in the long term? It would
hopefully empower victims to make their own decisions, help them to find
their own strengths, and thus help them to make the conscious decision to
move from being victims to being survivors and fighters.

Competing interests:  
None declared

Competing interests: No competing interests

01 January 2003
Sarah C Whippman
General Practitioner
Ranworth Surgery, 103 Pier Av, Clacton CO15 1NJ