Researchers have developed guidelines to assist physicians in dealing with wife abuse when the male and female partners are patients of the same physician. The guidelines appear in the September 10 issue of The Journal of the American Medical Association (JAMA).
A 1994 Statistics Canada survey of 12,300 women who had ever been in a common-law relationship or married revealed three out of 10 were abused by their partners at least once during their life. However, very little research has been done on the effect of a physician's decision making when he/she is caring for both partners.
"We developed the guidelines to help physicians balance medical and ethical issues and prioritize responsibilities when they're in this position," says lead investigator Dr. Lorraine Ferris, an associate professor in the department of public health sciences at the University of Toronto and senior scientist with Sunnybrook Health Science Centre's Clinical Epidemiology Unit. "It is not a conflict of interest for physicians to deal with wife abuse when both the partners are patients. The guidelines will help them provide both patients with autonomy, confidentiality, honesty and quality of care."
Ferris, who is also a senior scientist at the Institute for Clinical Evaluative Sciences, says the guidelines cover three areas: general issues, recognizing domestic violence and managing domestic violence. She and her team of investigators developed the guidelines with assistance from an expert panel and a consulting group, and also received valuable input from focus groups which included 48 previously abused women and 10 previously abusive men.
The guidelines suggest that physicians should seek permission from a woman before speaking to her partner about the possibility of abuse. When both partners are a physician's patient, individual counselling may be appropriate if the physician is trained to deal with violence. Joint or marital counselling is discouraged except under very specific circumstances and only when the physician is trained to conduct counselling without escalating the violence.
"It is critical that the physician determine the risk to a woman's safety, especially a risk of domestic homicide, and not be influenced by knowledge of the abusive partner when making the assessment," says Ferris. "Abused wives and their husbands have different needs and therefore require different interventions."
Funding for the development of these guidelines was provided by Health Canada.
CONTACT:
Christina Marshall
U of T Public Affairs
(416) 978-5949
Journal
JAMA