Bulletin

Issue: July 2006

Research in Action

GPs role in fight against family violence

When La Trobe social scientist Dr Angela Taft initially investigated the way general practitioners in Australia manage families affected by violence between partners, she found that GPs not only regularly overlooked the impact of partner violence on children, but there were also serious limitations in their abilities to manage the consequences for the families involved - or even for the safety of colleagues and staff in their own clinics.

Apart from the common barriers of lack of time and training, she says GPs also lacked any effective process for managing the situation when things got worse - or for recognising that their own attitudes and perceptions may often stand in the way.

'GPs had a range of attitudes that ran the gamut from “I think they're all bastards, I'd run over them on a dark night”, as one rural GP said about abusive male patients, to “It's really difficult to think of the men as abusers when you've been seeing both of them as a couple for a long time; I had no idea,”' Dr Taft says.

'There was a really strong realisation from that study that GPs needed better advice.'

The cross-currents tapped into during her PhD research in 2000 had such complex implications for GP management practices that Dr Taft has since extended her work into several major collaborative studies addressing the health system's response to intimate partner violence.

A Senior Research Fellow at La Trobe University's Mother and Child Health Research, she and a group of international partner violence and health care specialists have recently devised 32 innovative guidelines to assist GPs confront the many complex issues arising from domestic violence - to recognise when their own attitudes and prejudices may be blinding them, to identify patients who may be perpetrators, victims or at risk, especially women and children, and to act with confidence in managing the consequences, not least for their own clinics.

The result of a consensual, multinational research process led by Dr Taft, Associate Professor Kelsey Hegarty, from the University of Melbourne, and Professor Gene Feder from Queen Mary's School of Medicine and Dentistry, London, the guidelines have been endorsed by the Royal Australian College of General Practitioners for use by family physicians throughout Australia.

The group hopes the guidelines will be similarly endorsed by counterpart organisations in the UK, Canada, the Netherlands and the United States.

Delivering a 'Distinguished Paper' award presentation to a Plenary Session of the 2006 Australian General Practice and Primary Health Care Research Conference in Perth in July, Dr Taft told several hundred GPs and health care researchers she and her fellow-researchers acknowledged that partner violence is a global health problem, reflecting their shared understanding that it was an underlying issue in many serious and recurrent problems in primary health care.

The international consultative process from which the guidelines evolved had its provenance in a meeting Dr Taft and her principal researchers attended during an international family physicians' conference in Amsterdam in 2004.

Identifying the issues as global, the group invited diversely qualified experts from Australia, Canada, the US, the UK, and the Netherlands to help them evaluate recommendations - resulting in a two-year collaboration between 11 international universities and research institutes.

In Australia the research dovetailed under another major research project, a community randomised trial in the northwestern suburbs of Melbourne evaluating social support for pregnant and recent mothers at risk of abuse.

The guidelines are now also being trialled among 30 general practitioners participating in that project, which is also led by Dr Taft, Dr Rhonda Small and Professor Judith Lumley from Mother and Child Health Research, and Dr Hegarty. This project, like the international study, evolved from the findings of Dr Taft's original PhD research.

The most radical guidelines according to Dr Taft are those suggesting GPs ask all pregnant women and girls about partner violence, parents about the impact on their children, or ask the children themselves. She says there has been little awareness to date that this is appropriate, and doctors need to be mindful of the link between domestic violence and child abuse.

'These are issues which have been poorly addressed in general practice. They're important for the safety not only of the women and children, but also for the men, because some are homicidal, and some are homicidal and suicidal - and also for the clinics' own staff,' Dr Taft concludes.