While acknowledging that a ‘one size fits all’ approach to domestic violence training is not feasible, the RACGP president acknowledged that more needs to be done.
A Victorian coroner has doubled down on calls for the RACGP to institute yearly mandatory training related to family violence following the murder of an elderly woman.
Caroline Willis was murdered in May 2018 by her 40-year-old son Jamie Willis, whom she had taken out multiple Family Violence Intervention Orders against.
Around two years beforehand, Ms Willis’ GP had witnessed arguing between the pair and suggested they seek counselling to improve communication.
The GP also spoke to Jamie about a possible referral to a psychiatric nurse.
In early 2017, Ms Willis disclosed that she was the victim of financial abuse perpetrated by her son.
One year later, she told her doctor that Jamie had been threatening her and might be stealing her prescription medicines.
Ms Willis declined the GP’s suggestion of looking into residential aged care but accepted a referral to a mental health service where she was treated by a counsellor.
Around this time, the GP wrote in her consultation notes that discussions about the patient’s relationship with her son went “round and round and will never be resolved”.
Four months later, Ms Willis was stabbed to death.
State Coroner Judge John Cain was critical of the care that Ms Willis received.
“Ms Willis regularly saw her GP and disclosed the perpetration of family violence against her by Jamie on numerous occasions,” he wrote.
“In response Ms Willis’ GP suggested various support services to Ms Willis and Jamie, including mental health support and aged care.
“However, Ms Willis’ GP did not undertake any family violence risk assessment nor did she offer a referral to a specialist family violence service.”
Judge Cain said the doctor’s notes from the January 2018 appointment “reflect[ed] a lack of knowledge regarding possible responses to family violence”.
At the time, the RACGP White Book guideline advised GPs to ensure victim survivors received counselling and support from specialist family violence services but was mainly focused on intimate partner violence.
It has since been updated, but Judge Cain contended that references to specialist family violence services were generally made in the context of intimate partner violence.
“Whilst the RACGP has developed a six-hour online professional development program on family violence for GPs, it is not compulsory for GPs to undertake this or any other continuing professional development family violence training,” he wrote in a finding last month.
“This means that there are gaps within the broader GP community relating to their knowledge and skills in identifying and responding to family violence.”
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Given Ms Willis’ age and vulnerability, Judge Cain said the doctor should have followed RACGP guidelines on elder abuse, which includes making appropriate support referrals, exploring respite care and reporting immediate safety issues to police.
While he didn’t include it in the official recommendations section of the report, Judge Cain said he continued to support previous recommendations he had made around the matter.
“Given the prevalence of family violence in Australia and the critical role of GPs in responding to family violence, I find that it is inadequate to rely on the self-direction of GPs to undertake training in this area and note that without mandated family violence training, a portion of GPs will remain unskilled and ill-equipped to respond to patients’ disclosures of family violence,” he said.
RACGP president Dr Nicole Higgins said family violence cases were “bread and butter general practice”.
“Especially as female GPs, it’s something that we see on a daily basis,” she said.
“We also know that 20% of first disclosures from women are to their family doctor.
“This is something that we’re already sadly dealing with daily, but our GPs know the communities and know the supports, but we can always do better and always do more.”
The RACGP has previously said that it does not support a “one size” approach to family violence training.
“As a GP who has lived experience of domestic and sexual violence, enough’s enough,” Dr Higgins told The Medical Republic.
“And in a regional area, especially, it’s something that GPs are at the forefront of.
“Training for family and domestic violence is part of the curriculum at medical school, and also part of our curriculum for GPs in training.”
One of the challenges, she said, was that the resources available for domestic abuse victim survivors varied around the country.
Judge Cain also took aim at the lack of crisis accommodation for perpetrators of family violence, who he said were more likely to have the capacity to take responsibility for their behaviour when their basic needs were met.
Late on Friday afternoon, the federal government announced it would put an extra $900 million towards emergency housing for women and children leaving domestic violence situations.
More detail will be available in tomorrow night’s budget.
