GUIDELINES FOR MANAGING DOMESTIC ABUSE WHEN MALE AND FEMALE PARTNERS ARE PATIENTS OF THE SAME PHYSICIAN

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 w ith members having experience in family practice, gynecology, emergenc y medicine, medical ethics, nursing, psychology, law, and social work; an 11-member consulting group with members representing medicine, con sumers, police, psychology, social work, and nursing; and participants from focus groups including 48 previously abused women and 10 previou sly abusive men. Members of the expert panel and the consulting group were recruited by the research team, Focus group members were recruite d through the agencies from which they were receiving services. Eviden ce.-Available research information, and opinions of the expert panel, the consulting group, and the focus group participants. Consensus Proc ess.-Scoring of 144 clinical scenarios was performed by the expert pan el using a modified Delphi technique involving 4 iterations, Scenarios were rated in terms of best practice for primary care physicians deal ing with suspected and confirmed cases of physical abuse, Consulting g roup members and focus group participants then commented on the panel' s results. Final guidelines were approved by the panel and the consult ing group, with comments reserved in the guidelines for information fr om focus group participants. Conclusions.-It is not a conflict of inte rest for the physician to deal with abuse of the female partner when b oth partners are patients. Both patients have a right to autonomy, con fidentiality, honesty, and quality care. Patients should be dealt with independently, thereby facilitating assessment of the magnitude and s everity of the victim's injuries. Physicians should not discuss the po ssibility of domestic abuse with the male partner without the prior co nsent of the abused female partner. Joint counseling is generally inad visable and should be attempted only when the violence has ended, prov ided both partners give independent consent and the physician has adeq uate 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 q ualified physician is preferred.