Guidelines for managing domestic abuse when male and female partners are patients of the same physician. The Delphi Panel and the Consulting Group
L. E. Ferris, P. G. Norton, E. V. Dunn, E. H. Gort and N. Degani
Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada.
OBJECTIVE: To provide clinical guidelines for primary care physicians who
are dealing with domestic abuse and who have both the abused woman and her
partner as patients. PARTICIPANTS: A 15-member expert panel with members
having experience in family practice, gynecology, emergency medicine,
medical ethics, nursing, psychology, law, and social work; an 11-member
consulting group with members representing medicine, consumers, police,
psychology, social work, and nursing; and participants from focus groups
including 48 previously abused women and 10 previously abusive men. Members
of the expert panel and the consulting group were recruited by the research
team. Focus group members were recruited through the agencies from which
they were receiving services. EVIDENCE: Available research information, and
opinions of the expert panel, the consulting group, and the focus group
participants. CONSENSUS PROCESS: Scoring of 144 clinical scenarios was
performed by the expert panel using a modified Delphi technique involving 4
iterations. Scenarios were rated in terms of best practice for primary care
physicians dealing with suspected and confirmed cases of physical abuse.
Consulting group members and focus group participants then commented on the
panel's results. Final guidelines were approved by the panel and the
consulting group, with comments reserved in the guidelines for information
from focus group participants. CONCLUSIONS: It is not a conflict of
interest for the physician to deal with abuse of the female partner when
both partners are patients. Both patients have a right to autonomy,
confidentiality, honesty, and quality care. Patients should be dealt with
independently, thereby facilitating assessment of the magnitude and
severity of the victim's injuries. Physicians should not discuss the
possibility of domestic abuse with the male partner without the prior
consent of the abused female partner. Joint counseling is generally
inadvisable and should be attempted only when the violence has ended,
provided both partners give independent consent and the physician has
adequate training and skills to deal with the situation without escalating
the violence. If the physician feels unable to deal effectively with either
patient because of the dual relationship, referral to another qualified
physician is preferred.
