Shane Guna

A confidential conversation in your private practice

Internal diversity

I’ve umm’d and ahh’d about writing to this topic for a few weeks, but I feel compelled to.

Mostly because, in our field, we don’t ever talk about these things.

The uncomfortable truths that exist within the health system.

Domestic violence (DV) is very much a ‘health’ problem, in many respects.

It’s a problem that turns up to the front door of the Emergency Department on a daily basis.

I know, because I used to work in one.

And it’s the sort of problem as physiotherapists we tend to find uncomfortable.

The problem I see, at least for my cohort, is there was no training in DV during our undergrad years.

When I worked in ED I was up-skilled in this area.

I know now that in most hospital roles these trainings do exist.

It’s an area where all health professionals ought to up-skill though.

Yet most physiotherapists nowadays go straight to private practice.

And perhaps these opportunities are being missed.


What primary practitioners need to know

For a primary contact practitioner, I see it as akin to having a first aid certificate.

Because there are women who need first responders.

And there’s an expectation that we can be those people.

Chances are your client may disclose information to you, knowing you’re a health professional.

Knowing that you are inside the system that is meant to protect them.

I remember a girl coming to see me about her shoulder.

This was back in my Angliss Hospital days in Community Health.

I was still pretty junior at the time.

In fact, this was probably my first proper musculoskeletal physio work and my head was very much focussed on ‘fixing’ bodies.

She dropped a lot of hints to me.

She even showed me text messages.

Emotional abuse, more than physical.

But in the week’s I had been seeing her she was withering away.

She had lost so much weight in that time I didn’t even know how to manage her shoulder.

Unfortunately, with my biomedical brain on I was more concerned about red flags for weight loss.

I’d at least spoken to her about that, and I even wrote to her GP.

Eventually it clicked though and we had that conversation.

I tried to get a social worker to come and see her in one of our consults.

But it never eventuated.

I hoped at the time I’d done enough.

But I’ll never know…


Physio the new hairdresser

The most common place for people to disclose DV is actually to hairdressers.

It’s a safe space.

Woman tend to be ‘allowed’ to go here.

And there are seldom any men around.

It’s a unique opportunity to discuss some personal challenges in depth.

Usually as a client may be there for hours and often has a close personal relationship with their stylist.


Physio clinics should be a safe space too

A safe place where the majority of clients tend to be female.

In terms of next action, I’d highly recommend people get up-skilled in the basics.

Like I said earlier, it’s akin to having a first aid certificate nowadays.

Noting, there’s a lot of complexity in this area.

We can’t always intervene in such a way that changes these situations.

But we are better to do something than turn the other way.

We are better to at least have resources on hand.

Right now, given how topical this issue is.

I think it’s worth having a conversation internally.

Start by asking these questions of yourself, your therapists and your admin:

  1. Would you RECOGNISE the signs of someone who is being abused?
  2. Do your team know how to RESPOND if someone discloses DV to them?
  3. Do you have resources available in your practice to REFER towards?

A good place to start is here:

http://www.dvalert.org.au/about/about-the-training

Some additional resources are listed below:

Family and domestic violence support:

If this article raises any issues for you, then you should consider talking to your GP or to one of these support agencies:


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