From subtle symptoms to disclosure: Communication in violence detection in primary care

BACKGROUND: Identifying victims of interpersonal violence remains a challenge for general practitioners, who must rely on subtle clinical cues and foster an environment conducive to disclosure. OBJECTIVES: To describe the symptoms, behaviours, and communication strategies that facilitate the recognition of interpersonal violence in primary care consultations. METHODS: For this qualitative study, general practice consultations by three physicians in the Poitou-Charentes department, France, were audio-recorded from June to September 2019. Adult patients (≥18 years, fluent in French) were included unless they rejected audio recording. Only the audio-recording of consultations during which interpersonal violence was disclosed were analysed following an inductive approach to identify categories and themes until saturation was reached. RESULTS: In total 25/326 patients disclosed experiences of violence. Detection combined verbal cues (vague somatic complaints, ambiguous trauma references) by the patient and open-ended or direct questions by the general practitioners. Techniques included linking symptoms to violence, broad funnel questions, and most effectively, direct queries, such as 'Did someone hurt you?. The three physicians adapted their approach, balancing respect for the patient readiness and clinical conviction, often revisiting the topic from different perspectives. Empathy and a trusted doctor-patient relationship proved crucial for violence disclosure. CONCLUSION: Our findings highlight the value of the physicians' tenacity and empathic attitude for identifying hidden situations of violence, and suggest that integrating these strategies in routine general practice can enhance detection. The findings underscore the need of training physicians in patient-centred communication and suggest future research avenues for refining detection protocols in primary care.