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Domestic violence is one of the most widespread and hidden public health problems worldwide. General practitioners (GPs) are often the first professionals that victims meet, so recognizing the signs and responding appropriately is essential.

This was the focus of the workshop “Making primary care a safe space for survivors of family violence,” led by Wei-May Su, MBBS, an Australian GP specializing in mental health, sexual abuse, and violence. She is a coauthor of the Royal Australian College of General Practice (RACGP) Guideline of Abuse and Violence (White Book) and the chair of the RACGP Abuse and Violence in Families Specific Interest Group.

The session, which drew one of the largest audiences at the 25th World Organisation of Family Doctors (WONCA) World Conference 2025 in Lisbon, Portugal, divided participants into subgroups and asked them to answer a series of questions that were later shared with the full assembly of the conference.

According to the World Health Organization, 1 in 3 women worldwide have experienced domestic violence, and 1 in 2 children have been victims of abuse. Despite these figures, very few victims have disclosed their situation to health care professionals. When they do, the practitioner’s reaction determines whether they seek further help.

Recognizing the Signs

Victims rarely show physical signs of abuse. Instead, the symptoms can be vague, chronic, or recurring, such as back pain, headaches, gastrointestinal disorders, or palpitations. Repeated emergency visits without clear findings may raise suspicion.

Hesitation when asked about trauma, inconsistencies in medical history, and frequent use of painkillers and antidepressants are indicators.

In one reported case, a woman with severe back pain had a long history of fibromyalgia, recurrent abdominal pain, palpitations, and miscarriages. A series of symptoms masks the underlying domestic control and abuse.

Nonverbal signs should also be noted; a lack of eye contact, visible anxiety, or reluctance to be examined may raise suspicion of physical abuse at home.

Creating a Safe Space

Therefore, a safe approach that considers both trauma and violence is essential for effective intervention. One doctor suggested that the patient must be put at ease, for example, by reminding them that domestic violence is unfortunately common but that it should not be trivialized. Make the victims feel that they are not alone and that they are not being judged by others.

It is vital to guarantee their physical and emotional safety and remind them that everything that happens in a doctor’s clinic is strictly confidential. Offering choices during care helps restore autonomy. As Su stressed, the GP collaborates with the survivors and not with them.

Practical Measures

Doctors have suggested several methods for identifying and supporting victims when abuse is suspected.

• Ask to see the patient alone for part of the consultation.
• Explain each step of the physical examination and seek explicit consent.
• Use inclusive language and ask patients how they wish to be addressed, especially lesbian, gay, bisexual, transgender, and queer or questioning+ patients.
• Ask simple, direct questions: Although time constraints often discourage GPs, asking more intimate questions can help reveal violence. Simple and compassionate questions can open doors questions, such as “Do you feel safe at home?” or “Has anyone ever hurt you or tried to control what you do, who you see, or how you spend your money?”

If the victim confides in the GP, the GP does not need to provide all answers. What matters is validating the patient’s experience, avoiding minimizing or questioning it, and offering support to the patient. However, the patient will not necessarily open up during the first consultation. It can take months or even years to establish a relationship of trust. Follow-up video conferences and repeated visits to address chronic issues can create the right conditions for patients to open up.

Role of the Whole Practice

Responding to trauma care extends beyond the scope of GP. Receptionists, nurses, and other staff members should be aware of how to respond appropriately.

Visible signs in the waiting room, such as leaflets, posters, or discreet quick response codes in the toilets linked to support services, indicate to patients that the clinic is safe and supportive.

In some countries, confidential notes are added to medical records that are accessible only to doctors, helping to protect sensitive information from unintended legal or social repercussions.

Referral and Networks

GPs must familiarize themselves with local resources, such as social workers, nongovernmental organizations, shelters, helplines, and police contacts. Many survivors stated that their doctors could have done more if they had known where to refer them.

“Let us not forget that referral is not abandonment. Addressing the risks that victims face in legal or police proceedings helps maintain continuity of care,” said Su.

Addressing Stigma

Domestic violence affects all communities, but experiences differ across them. Survivors may face additional barriers related to sexuality, immigration status, language, and socioeconomic dependence. 

In countries with large communities of foreign residents, abusers may exploit victims’ fear that they will not receive help because they are not citizens. Clear communication about the available support is essential to ensure that all victims know that help is accessible, regardless of their origin.

For survivors, the most important qualities of health care professionals are kindness, compassion, and honesty. Listening, recognizing their suffering, and offering support can be the first steps toward ending the cycle of violence. 

This story was translated from MediQuality.