Julie Penfold

Domestic abuse is a leading cause of violence against women in Europe. In France alone, 122 women were killed by their partner or ex-partner in 2021. A 2024 study led by French GP Dr Noémie Deparis, who has expertise in domestic violence, revealed that female victims often want their GPs to recognize signs of abuse and offer support. 

In this interview with Medscape, Deparis provides practical advice for doctors on identifying the subtle signs of domestic violence and offering compassionate, effective support to affected patients.

How can GPs identify victims of domestic abuse during consultations? What are the signs and symptoms they should look out for?

GPs play an important role in identifying victims of domestic violence or child abuse. They need to be alert to any signs that might suggest violence. Physical signs may include unexplained or recurring injuries, scars, and bruising in unusual areas such as the torso, back, or face. Delays in seeking care for their injuries may also be a cause for concern.

There are also psychological signs to look out for, including anxiety, depression, sleep problems, and lowered self-esteem. Other signs can include a change in the patient’s behavior or avoidance behavior. A partner who dominates the consultation, prevents the victim from speaking freely, or watches her excessively could also be an indicator.

There are also contextual signs to look out for — for example, frequent consultations for chronic pain, and multiple reasons for vague, unexplained symptoms such as headaches, abdominal pain, and chronic fatigue. A medical history that is incompatible with the explanations given by the patient can also be a warning sign, as can medical nomadism, where a patient consults with multiple GPs for the same symptoms over a period of time. 

It is crucial to remember that domestic violence can affect individuals across all sociocultural backgrounds, ages, and sexual orientations. Every GP’s patient population includes people who may have experienced domestic violence. In my practice, I’ve developed the habit of reminding myself that when there’s a patient I don’t understand or the situation isn’t clear, it’s often a signal to ask the question.

How can GPs initiate conversations on the topic sensitively, should they have concerns?

For GPs to be able to ask the question systematically when they suspect violence, the most important point is that they themselves should be comfortable with the question they are asking. Obviously, the question must be asked in a nonjudgmental way and in a safe and confidential environment. 

The question can be asked systematically, with a direct question and a routine to normalize the topic. For example: “This is a question I ask all my patients: Have you ever experienced violence in your life?”

GPs can also approach the subject in a more general way. For example: “You seem to be under a lot of stress recently. Is everything okay at home?” or “Sometimes when patients come in with these symptoms, they may be under pressure or experiencing stress in their lives. Could this be the case for you?”

It is essential to express understanding without insistence, depending on the patient’s response. 

Are there specific protocols or guidelines in Europe for recognizing and addressing such cases?

I don’t know enough about the particularities of each European country, but in France since 2022, the French National Authority for Health has recommended systematic screening for domestic violence. The French National Medical Council has also issued recommendations for medical certificates and reporting to the judicial authorities of victims of violence without their consent in cases of control and risk of serious and imminent danger. 

The French College of General Practitioners has recently published practical information sheets to help GPs deal with violence. For more than 5 years, the Déclic Violence website has been regularly updated to help GPs deal with and support victims of violence. Across France, an increasing number of women’s centers are being set up in every region. These centers serve as essential resources, not only for women experiencing violence but also for professionals assisting them.

Could you describe what happens in Europe once a GP confirms that a patient is a victim of domestic violence, including what steps they would take and what support is available?

When a doctor confirms a situation of violence, it is important to provide an active listening ear, a safe space, and immediate support adapted to the victim’s situation and wishes. All the information brought to our attention must be written in the medical file, both the facts reported and the physical or psychological clinical findings. This information should enable us to draw up a descriptive medical certificate at the time of the consultation, if the victim so wishes, or at a later date.

It is important not to be left on your own and to refer the victim to other health professionals; to legal, judicial, or social aid structures; to local or national associations; or to a victim support number. 

How can GPs ensure that their involvement helps victims to access broader support systems such as shelters or counseling services?

As in many areas of medical care, GPs have an important role to play in coordinating the efforts of all the professionals involved. Victims of domestic violence often require long-term monitoring, with periods of improvement and setbacks. In my consultations, I often use the concept of the cycle of violence to help patients recognize the powerful control mechanisms at play. Collaboration with support networks ensures that the victim is not isolated after their GP consultation.

What role can GPs play in documenting cases to assist with legal or social interventions?

GPs play a crucial role in documenting cases of domestic violence to support legal and social interventions. This involves maintaining detailed, objective medical records that include descriptions of injuries, the patient’s account in their own words, psychological observations, and findings from physical examinations.

GPs can issue legally recognized medical certificates detailing the injuries and their consistency. Photographic evidence, with patient consent, can further substantiate claims. GPs also contribute to risk assessments, identifying immediate dangers to the victim or others, which inform protective actions by social services or law enforcement. 

 

A version of this article appeared on Medscape.com.

Domestic abuse is a leading cause of violence against women in Europe. In France alone, 122 women were killed by their partner or ex-partner in 2021. A 2024 study led by French GP Dr Noémie Deparis, who has expertise in domestic violence, revealed that female victims often want their GPs to recognize signs of abuse and offer support. 

In this interview with Medscape, Deparis provides practical advice for doctors on identifying the subtle signs of domestic violence and offering compassionate, effective support to affected patients.

How can GPs identify victims of domestic abuse during consultations? What are the signs and symptoms they should look out for?

GPs play an important role in identifying victims of domestic violence or child abuse. They need to be alert to any signs that might suggest violence. Physical signs may include unexplained or recurring injuries, scars, and bruising in unusual areas such as the torso, back, or face. Delays in seeking care for their injuries may also be a cause for concern.

There are also psychological signs to look out for, including anxiety, depression, sleep problems, and lowered self-esteem. Other signs can include a change in the patient’s behavior or avoidance behavior. A partner who dominates the consultation, prevents the victim from speaking freely, or watches her excessively could also be an indicator.

There are also contextual signs to look out for — for example, frequent consultations for chronic pain, and multiple reasons for vague, unexplained symptoms such as headaches, abdominal pain, and chronic fatigue. A medical history that is incompatible with the explanations given by the patient can also be a warning sign, as can medical nomadism, where a patient consults with multiple GPs for the same symptoms over a period of time. 

It is crucial to remember that domestic violence can affect individuals across all sociocultural backgrounds, ages, and sexual orientations. Every GP’s patient population includes people who may have experienced domestic violence. In my practice, I’ve developed the habit of reminding myself that when there’s a patient I don’t understand or the situation isn’t clear, it’s often a signal to ask the question.

How can GPs initiate conversations on the topic sensitively, should they have concerns?

For GPs to be able to ask the question systematically when they suspect violence, the most important point is that they themselves should be comfortable with the question they are asking. Obviously, the question must be asked in a nonjudgmental way and in a safe and confidential environment. 

The question can be asked systematically, with a direct question and a routine to normalize the topic. For example: “This is a question I ask all my patients: Have you ever experienced violence in your life?”

GPs can also approach the subject in a more general way. For example: “You seem to be under a lot of stress recently. Is everything okay at home?” or “Sometimes when patients come in with these symptoms, they may be under pressure or experiencing stress in their lives. Could this be the case for you?”

It is essential to express understanding without insistence, depending on the patient’s response. 

Are there specific protocols or guidelines in Europe for recognizing and addressing such cases?

I don’t know enough about the particularities of each European country, but in France since 2022, the French National Authority for Health has recommended systematic screening for domestic violence. The French National Medical Council has also issued recommendations for medical certificates and reporting to the judicial authorities of victims of violence without their consent in cases of control and risk of serious and imminent danger. 

The French College of General Practitioners has recently published practical information sheets to help GPs deal with violence. For more than 5 years, the Déclic Violence website has been regularly updated to help GPs deal with and support victims of violence. Across France, an increasing number of women’s centers are being set up in every region. These centers serve as essential resources, not only for women experiencing violence but also for professionals assisting them.

Could you describe what happens in Europe once a GP confirms that a patient is a victim of domestic violence, including what steps they would take and what support is available?

When a doctor confirms a situation of violence, it is important to provide an active listening ear, a safe space, and immediate support adapted to the victim’s situation and wishes. All the information brought to our attention must be written in the medical file, both the facts reported and the physical or psychological clinical findings. This information should enable us to draw up a descriptive medical certificate at the time of the consultation, if the victim so wishes, or at a later date.

It is important not to be left on your own and to refer the victim to other health professionals; to legal, judicial, or social aid structures; to local or national associations; or to a victim support number. 

How can GPs ensure that their involvement helps victims to access broader support systems such as shelters or counseling services?

As in many areas of medical care, GPs have an important role to play in coordinating the efforts of all the professionals involved. Victims of domestic violence often require long-term monitoring, with periods of improvement and setbacks. In my consultations, I often use the concept of the cycle of violence to help patients recognize the powerful control mechanisms at play. Collaboration with support networks ensures that the victim is not isolated after their GP consultation.

What role can GPs play in documenting cases to assist with legal or social interventions?

GPs play a crucial role in documenting cases of domestic violence to support legal and social interventions. This involves maintaining detailed, objective medical records that include descriptions of injuries, the patient’s account in their own words, psychological observations, and findings from physical examinations.

GPs can issue legally recognized medical certificates detailing the injuries and their consistency. Photographic evidence, with patient consent, can further substantiate claims. GPs also contribute to risk assessments, identifying immediate dangers to the victim or others, which inform protective actions by social services or law enforcement. 

 

A version of this article appeared on Medscape.com.

Domestic abuse is a leading cause of violence against women in Europe. In France alone, 122 women were killed by their partner or ex-partner in 2021. A 2024 study led by French GP Dr Noémie Deparis, who has expertise in domestic violence, revealed that female victims often want their GPs to recognize signs of abuse and offer support. 

In this interview with Medscape, Deparis provides practical advice for doctors on identifying the subtle signs of domestic violence and offering compassionate, effective support to affected patients.

How can GPs identify victims of domestic abuse during consultations? What are the signs and symptoms they should look out for?

GPs play an important role in identifying victims of domestic violence or child abuse. They need to be alert to any signs that might suggest violence. Physical signs may include unexplained or recurring injuries, scars, and bruising in unusual areas such as the torso, back, or face. Delays in seeking care for their injuries may also be a cause for concern.

There are also psychological signs to look out for, including anxiety, depression, sleep problems, and lowered self-esteem. Other signs can include a change in the patient’s behavior or avoidance behavior. A partner who dominates the consultation, prevents the victim from speaking freely, or watches her excessively could also be an indicator.

There are also contextual signs to look out for — for example, frequent consultations for chronic pain, and multiple reasons for vague, unexplained symptoms such as headaches, abdominal pain, and chronic fatigue. A medical history that is incompatible with the explanations given by the patient can also be a warning sign, as can medical nomadism, where a patient consults with multiple GPs for the same symptoms over a period of time. 

It is crucial to remember that domestic violence can affect individuals across all sociocultural backgrounds, ages, and sexual orientations. Every GP’s patient population includes people who may have experienced domestic violence. In my practice, I’ve developed the habit of reminding myself that when there’s a patient I don’t understand or the situation isn’t clear, it’s often a signal to ask the question.

How can GPs initiate conversations on the topic sensitively, should they have concerns?

For GPs to be able to ask the question systematically when they suspect violence, the most important point is that they themselves should be comfortable with the question they are asking. Obviously, the question must be asked in a nonjudgmental way and in a safe and confidential environment. 

The question can be asked systematically, with a direct question and a routine to normalize the topic. For example: “This is a question I ask all my patients: Have you ever experienced violence in your life?”

GPs can also approach the subject in a more general way. For example: “You seem to be under a lot of stress recently. Is everything okay at home?” or “Sometimes when patients come in with these symptoms, they may be under pressure or experiencing stress in their lives. Could this be the case for you?”

It is essential to express understanding without insistence, depending on the patient’s response. 

Are there specific protocols or guidelines in Europe for recognizing and addressing such cases?

I don’t know enough about the particularities of each European country, but in France since 2022, the French National Authority for Health has recommended systematic screening for domestic violence. The French National Medical Council has also issued recommendations for medical certificates and reporting to the judicial authorities of victims of violence without their consent in cases of control and risk of serious and imminent danger. 

The French College of General Practitioners has recently published practical information sheets to help GPs deal with violence. For more than 5 years, the Déclic Violence website has been regularly updated to help GPs deal with and support victims of violence. Across France, an increasing number of women’s centers are being set up in every region. These centers serve as essential resources, not only for women experiencing violence but also for professionals assisting them.

Could you describe what happens in Europe once a GP confirms that a patient is a victim of domestic violence, including what steps they would take and what support is available?

When a doctor confirms a situation of violence, it is important to provide an active listening ear, a safe space, and immediate support adapted to the victim’s situation and wishes. All the information brought to our attention must be written in the medical file, both the facts reported and the physical or psychological clinical findings. This information should enable us to draw up a descriptive medical certificate at the time of the consultation, if the victim so wishes, or at a later date.

It is important not to be left on your own and to refer the victim to other health professionals; to legal, judicial, or social aid structures; to local or national associations; or to a victim support number. 

How can GPs ensure that their involvement helps victims to access broader support systems such as shelters or counseling services?

As in many areas of medical care, GPs have an important role to play in coordinating the efforts of all the professionals involved. Victims of domestic violence often require long-term monitoring, with periods of improvement and setbacks. In my consultations, I often use the concept of the cycle of violence to help patients recognize the powerful control mechanisms at play. Collaboration with support networks ensures that the victim is not isolated after their GP consultation.

What role can GPs play in documenting cases to assist with legal or social interventions?

GPs play a crucial role in documenting cases of domestic violence to support legal and social interventions. This involves maintaining detailed, objective medical records that include descriptions of injuries, the patient’s account in their own words, psychological observations, and findings from physical examinations.

GPs can issue legally recognized medical certificates detailing the injuries and their consistency. Photographic evidence, with patient consent, can further substantiate claims. GPs also contribute to risk assessments, identifying immediate dangers to the victim or others, which inform protective actions by social services or law enforcement. 

 

A version of this article appeared on Medscape.com.