AMA Transcript - Family violence; smoking bans

BRIAN OWLER: Okay, well thank you for coming out this afternoon on a Sunday. The AMA National Conference for 2015 just finished. Today we had a session on public health, and one of the most important issues discussed today was that of domestic violence. Domestic violence, of course, is receiving a lot of attention, but one of the most frequent areas that victims present to is their general practitioner.

A general practitioner is often the first port of call for people and it's important that we assist our GPs in being able to first of all identify but also initiate a discussion with potential victims of domestic violence. Once that's happened, of course, they need to know the resources that are available to help that particular individual. And so what we've done today, in conjunction with the Australian Law Council, is to put together a toolkit for our doctors to allow them and assist them in dealing with the issue of domestic violence, both to identify it, but also to initiate a conversation and then, of course, allow them to direct the individual in the right direction in terms of resources.

It's a really important topic and it's a much too common feature that our GPs tell us is part of their practice. Too frequently they are dealing with victims of domestic violence, and so what we need to do is assist them to make sure that we help not only deal with the victims, but also put an end to this problem in Australian society. I've got Duncan McConnel, the President of the Australian Law Council. I'd like to ask him to say a few words.

DUNCAN McCONNEL: Thanks very much, Brian. I think one of the most important messages to come out of today is that domestic violence is not just a law and order issue. It's a broader issue, and in particular it's a health issue. It's a health issue for a number of reasons, including the mental health of people affected by domestic violence as well as the physical aspects of people who are injured by violence. It's an issue for children and it's an issue that touches all aspects of our lives, including, for example, homelessness.

Each of those aspects of family violence and domestic violence in turn feeds into the enormous cost of the health system, in the same way that it does to the legal system. A recent Senate committee of inquiry identified that one of the big barriers for people seeking help with domestic violence and family violence is the lack of coordination across services.

We hope that this tool will be an important step forward in providing greater coordination between the medical profession and the legal profession in helping victims of family and domestic violence to access services without having to go through the sort of revolving door of seeking help from different service, after different service, after different service. It's been identified as a critical issue and with the AMA today I think we've taken a first vital step. Thank you.

QUESTION: Professor Owler, what kind of health issues would victims of domestic violence come to GPs with?

BRIAN OWLER: Well, often they present to GPs sometimes with unrelated issues. And one of the things that GPs do, particularly when they've got regular patients, is they get to know that person, so sometimes if they present with a very minor ailment, it might actually be the sign of something more serious. So one of the things that GPs need to do is actually just ask the right questions. Perhaps ask how things are going generally in their life, how things are going with their partner, for instance, so there are a range of issues, or ways that doctors can actually initiate a conversation in a safe way.

There are also questions that they shouldn't ask when someone does disclose that they've been a victim of domestic violence. They shouldn't for instance suggest that there might be any blame on the victim. What could you have done to avoid this, for instance, is one of those questions that might imply blame. even though it might be a very innocent question.

So it is such a sensitive topic and we need to not only help the victims but also empower our doctors, particularly our GPs, to do this in a sensitive way that encourages people to come forward and encourages people to actually share their experiences so that the doctor can then refer them to the appropriate resources.

QUESTION: Are there any legal obligations for doctors in terms of reporting suspected violence to police?

BRIAN OWLER: There are. The document actually goes through and lists the obligations in various States and Territories, and I'll ask Duncan to comment on this in a moment. But I understand that, for instance, in the case of children, States and Territories all have mandatory reporting requirements.

In the case of adults, I understand the Northern Territory is the only jurisdiction where there is a mandatory reporting requirement for adults. It's a complex issue and what you don't want to do, particularly in the case of an adult, is set up a system where you might deter people from coming forward and having a conversation with their GP.

We know that that relationship between a doctor and a patient is a very sacred relationship. That issue of confidentiality and what you say to the doctor is something that should be kept in confidence, except in very extreme circumstances. So we need people to have confidence in actually being able to disclose to their GP that there may be an issue at home and feel safe about doing that. Because once a report is lodged, of course, a number of other things are triggered and we want to ensure that people will come forward and share that with us. But I might ask Duncan to comment, if that's okay.

DUNCAN McCONNEL: I think two aspects to that. One is it's important for doctors and health professionals to know when they have to report and, as Professor Owler said, in relation to violence and assaults in relation to children there's mandatory reporting. That's not across the board in relation to adults. So it's important that doctors and health staff know when they are required to report, but also know when they're not required to report, so that that doctor-patient confidentiality is maintained where it should be.

But the other aspect of this tool is to actually provide information to doctors and health staff about how to report when they do report. And increasingly you're seeing very specialised services even within police forces so that when you are reporting domestic violence or family violence you are encouraged to report that to a specialised team rather than just picking up the phone and dialling 911, and just getting a general police response.

In many cases that's not the appropriate way of reporting and indeed can put a victim of abuse at greater risk. So it's about informing doctors and the health professions about what services are available and specific ways of reporting when they do report.

QUESTION: Is this something that doctors have asked you for help and advice on? Is it the case where they're seen because they don't know what they should do about the situation?

BRIAN OWLER: Look, we know it's a very common way for people to present. We know that, certainly, victims do present to police quite frequently, but we know that GPs are actually another - probably the second most common area where people are identified.

So this was actually initiated in New South Wales, through the New South Wales Women's Legal Service. They approached the AMA. They recognised the fact that many people had been to their GPs. And so we launched the toolkit initially in New South Wales in a smaller version. That grew to be very, very popular, of great interest to our GPs, and I think that just highlights the fact that this sort of resource is really useful for GPs.

We know that, because so much attention has been put on this issue in the media and by people such as Rosie Batty, there is more likely to be further reports, more people coming forward - we hope - and so it's important that our GPs are prepared when people do come forward that they have the right resources and the right information to allow and assist them to prescribe the right treatment.

QUESTION: Well how does this resource differ to other resources or other guidelines that may have been available to doctors previously?

BRIAN OWLER: Well, there're probably not that many guidelines. It does bring it into a central place. It brings together a number of resources all together and I think the really unique feature about this document is that it really does start from the beginning. It starts from the things you need to look for to identify potential victims. Whether it might be an adult, a woman, or it might be a child. But then I think the crucial thing is initiating that conversation, asking the right questions and so that you can introduce that topic and people feel safe to actually have that conversation with their GP.

I think it's a very difficult and uncomfortable issue. Not only for, obviously, the victim, but also often for the GP, particularly when they might know not only the victim but also the perpetrator in their practice as well. So it is a complex situation, and having that toolkit with all of these things, including the list of resources, brought together under one document I think will be very useful for GPs

QUESTION: [indistinct question]

BRIAN OWLER: We've only got really anecdotal evidence that that might be the case. But I think if you talk to most GPs and it doesn't really matter where they work - I meant that's another feature of domestic violence, it is something that falls across all areas of our country unfortunately - it is a very significant proportion of the sort of issues they have to deal with in their practice. So yes, while there might be an increase, the underlying need has always been there, and hopefully we can reduce that.

QUESTION: Can one of you talk [indistinct] someone who discloses domestic violence and the doctor knows that there are children involved, where - when would the doctor have to pass on that information?

DUNCAN McCONNEL: It's not an easy question to answer, and I think the most important thing is for doctors to understand that if they are confronted with that sort of situation, they need to seek advice if they are unsure. The obligation to report is often couched in terms of an obligation to report if that is the first occasion when it has been identified.

So if you come into a case that is already ongoing and where there are already services involved, then that obligation isn't triggered. So it's really important to look at each case individually and,. if you're not sure, to seek advice.

QUESTION: In saying that before, Duncan, I think you touched on as well that providing doctors with this sort of advice also allows patients to know that they can - it's obviously an extremely traumatic period for them - take that first step of going to their doctor, that their doctor can then help take it further with them if they so wish.

DUNCAN McCONNEL: Certainly, I mean if you get someone who is a victim of violence finally being prepared to disclose it, then the worst thing that can possibly happen is that no-one knows where to go next, and I am hoping that this sort of tool will actually provide both victims of violence, but also the doctors and the health professionals who are involved in providing services, to know where to go next in trying to help someone with their issues.

QUESTION: You also mentioned before, earlier in the conference, the quite staggering statistics regarding domestic violence in Queensland and Australia and the cost on the healthcare system.

DUNCAN McCONNEL: Yes, and part of the reason for the collaboration between the Law Council and the AMA is that I think we've identified that we need to actually start to bring those costs to the community down, and that means we need to start focusing our attention on prevention and early intervention. For the legal profession, particularly, and Legal Aid services, they're really in the business of mopping up.

They're coming after - whether it's violence or whether it's other criminal conduct - but they're coming at the back end and helping either victims or defendants and offenders go through the criminal justice system. But we're not able to do anything about actually reducing the causes of people coming into the system.

So, early intervention and proper and coordinated responses at an early stage, I think, are critical to leading to a reduction in the overall cost of these problems to the community.

QUESTION: Brian, can you talk to the suggestion that people would use the doctor space when [indistinct question]

BRIAN OWLER: Well, first of all, it's important to be able to have a conversation with the victim or potential victim that might be identified in a confidential way, and so sometimes it's actually about being able to have that conversation alone, because it might be that the perpetrator and the victim might come to the consultation together. So there needs to be a way of actually having a consultation in private, and then there needs to be a method to try and manage the confidentiality of the victim, and to make sure, I guess, that that trust is not breached, and that nothing is disclosed between one patient and the other.

And it may be that, in a practice, that there are ways of separating patients with different GPs, but the main thing is to make sure that the victim is protected, and also to make sure that things are well documented should there be any issues that arise in the future.

QUESTION: [indistinct] also talk about making sure that if someone does disclose, making sure there is no immediate danger.

BRIAN OWLER: Yes.

QUESTION: Including asking, 'Is it safe for you to go home now?

BRIAN OWLER: Yes.

QUESTION: You know, should you [indistinct]. But where does the doctor potentially go about sourcing, you know, accommodation, or - ?

BRIAN OWLER: And that's one of the resources that's provided in the toolkit, is the contacts of the resources that are there, so that they can direct them in the right direction, at least initiate contact between the victim and, for instance, a shelter or an organisation that might be able to arrange that emergency accommodation. So, yes, it is making sure that they are safe to go home, that the children - if there are children involved - that they are going to be safe and looked after. And that there is no potential, obviously, for immediate harm.

QUESTION: Have there been cases where [indistinct] emergency accommodation from the consultation room [indistinct]?

BRIAN OWLER: That's a potential, yes. So that's why actually having those resources and contacts at the GP's fingertips is so important. The last thing the victim or the GP needs to be doing is trying to fumble around looking up resources that they may not have had contact with before, so if they've got those resources that are well recommended and contact numbers are there, they can at least initiate those contacts.

QUESTION: What would you say to a patient, a victim of abuse, who is struggling to disclose that information to their doctor?

BRIAN OWLER: Look, it's obviously an extremely traumatic time for the person that's the victim, and it is a very difficult process. The job of the doctor is to make sure that a patient is protected and also totally to encourage them to disclose and have a conversation about their particular situation, and then put them in touch with the appropriate resources.

So, I think people should feel that they can go and see their GP, that they have got confidence in knowing that their GP has the resources at their fingertips, and that they know how to deal with the situation appropriately. Our GPs deal with these sorts of issues - very complex issues.

They're often dealing with very complex social and emotional issues, as well as these physical issues. So I think they're in a very good place to be able to provide appropriate advice.

QUESTION: Just quickly, just that the ANU has come out and its campuses are going to be smoke-free from July. What do you think about that move?

BRIAN OWLER: Look, smoking remains one of the biggest killers in our society, and the smoking rates are still far too high. So, the AMA is welcoming of any of these sorts of moves that restrict smoking that makes it more unacceptable and discourages people from taking up and continuing the habit. Because we know that far too many people die from lung cancer or other smoking-related diseases such as cardiovascular disease, and whatever we can do to reduce smoking rates is something that the AMA does support.

1 June 2015

CONTACT:                John Flannery                     02 6270 5477 / 0419 494 761

                                    Odette Visser                      02 6270 5412 / 0427 209 753