Date Published: 20 June 2007

What happened to privacy within one's own home ?

When does "medical treatment" stray into invading the privacy of patients and their families ?

This personal opinion article asks if the recent BMA "call for doctors to tackle unspoken epidemic of domestic abuse"
(Press Released on 19th June) is a step too far.

The British Medical Association (BMA) has called on medical doctors and other health professionals to be "increasingly aware of domestic abuse as an issue that needs urgent attention".

Awareness is one thing. A concern is how such suspicions are handled. In the first instance they can be no more than a concern or opinion on the part of the medical practitioner or his or her staff. It does not seem fair or reasonable to stigmatise anyone by documenting a mere opinion unless a "victim" has specifically mentioned or requested it: Documenting observations as possible police evidence at the request of, and with the consent of, the patient is not the same as "playing policeman" and attempting to flag as possible crimes incidents that the supposed "victim" does not consider, or wish to be considered, as such.

Every so often a health news item or press release highlights an extremely serious and important issue - such as domestic violence - then proposes a disproportionate response. Disproportionate responses may detract from everyone in an attempt to help a few (whether or not they welcome the "help" - or "interference", depending on one's point of view). In many ways, quiet, less noticeable, intrusions into the private areas of people's lives are the most worrying. Afterall, if a police officer arrives at your door demanding entry, you cannot fail to be aware of the situation. On the other hand, if a medical practitioner at an A&E Department suspects that a decorating or gardening injury was really due to the patient's loving partner striking him/her with a hard object in a fit of anger then the questions are likely to be subtle and, in any case, one would hope that the medical practitioner were concentrating on attending to the physical injury! For many reasons, perhaps including distraction due to physical pain, one might not notice a case being built against one's family by the people one expects to attend to the medical matter presented to them (e.g. a broken arm, or whatever) without prejudice.

The possible consequences are obviously damaging: If the public understand that medical practitioners at A&E Departments, GP Surgeries, and similar are automatically considering the possibility of all injuries being as a result of crimes and making preliminary enquiries to ascertain the circumstances surrounding the possibly suspected "crime" then at least some genuine victims and perhaps other patients will not gain access to attend for medical help as a result. This may be the case because people in the domestic environment who might otherwise have had sufficient concern and/or remorse to ensure that injuries are checked and treated will not do so for fear of repercussions.

Apart from making worse the predicament of some genuine victims of domestic violence, any policy involving medics "playing policeman" (or social worker, etc.) will also erode the trust that is vital to the doctor-patient relationship.

Put simply: Accidents do happen in the home. If one can just have a wound stitched or a broken bone set without interrogation about how the injury happened then one is much more likely to go for that medical help than if doing so might also further complicate one's life by intrusive questions and possible suspicion that one is either somehow to blame, or that one is a victim in a criminal situation.

There is an expression that "cobblers should stick to mending shoes".
Likewise, it could be argued that medical practitioners should concentrate on doing what is asked of them by their patient. That is, while offering extra services such as contacting the police, may sometimes be justified:
First and foremost - A&E staff should treat injuries as requested by the patient
They should not be encouraged to seek-out and pursue matters for which the patient does not welcome their intervention because patients' right to privacy and to choose how to live their own lives should be respected.

Domestic abuse is, of course, a serious matter. No-one is condoning or excusing it.
The police deal with such matters when asked to do so, and rightly so.

The subject of concern here is medical staff acting in such a way as might dissuade injured and possibly very vulnerable people from seeking their help when all that is required is treatment for a physical condition: It is important that medics treat medical conditions and injuries in a manner that is sufficiently impartial and non-judgmental that those who need their services are not dissuaded from accessing them.

Source: Article submitted to IvyRose.

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