Domestic violence and the general practitioner.

Domestic violence is a common social problem that raises many difficult questions and management issues for both the patient and the doctor. Domestic violence is an abuse of power within the relationship. Physical assault is common and serious, but psychological abuse is more damaging. Perpetrators of domestic violence do not usually perceive that they have a problem and no change in their behaviour is possible unless they want to change. For general practitioners the first step in dealing with domestic violence is detection, and that means acknowledging that it can exist in any patient. General practitioners have three choices in their management of victims of domestic violence: they can do nothing, they can be sympathetic only or they can be an agent of change. Effective management of domestic violence involves raising the victim's self-esteem so that she is able to alter her situation herself.