The lifting of medical secrecy in cases of domestic violence, point of view of general practitioners in Isère ; La levée du secret médical dans le cadre des violences conjugales, le point de vue des médecins généralistes en Isère

Context: Domestic violence concerns an average of 295,000 victims per year and is still underestimated by statistical studies. Following the 2019 Grenelle about domestic violence, a law was enacted in July 2020. This law allows general practitioners to lift medical confidentiality in cases of domestic violence, by making a report to the public prosecutor. This law may be applies if there is an immediate danger and if the victim is unable to protect herself, because of the hold exercised on her by the perpetrator. Medical confidentiality can then be lifted with or without the victim's consent. This law has given rise to mixed reactions within the medical and paramedical profession : while some consider it a new lever in the fight against domestic violence, others find it inappropriate or even infantilizing. Objective: The objective of this study was to analyze the point of view of general practitioners working in Isère concerning the lifting of medical confidentiality in cases of domestic violence. Methods: We conducted a qualitative study using semi-structured interviews based on the grounded theory method. The study was conducted between January and June 2022, until data saturation, and included 12 general practitioners. Results: The decision to lift medical confidentiality depends on personal and professional factors specific to each physician, such as their knowledge of violence, the relationship established with their patients, their commitment, the missions related to their roles, and their representations. Despite the knowledge of numerous criteria for identifying asymmetry in a couple, the evaluation of the situation, and in particular of the hold and immediate danger, is considered subjective and in practice difficult to carry out. Doctors therefore consider lifting medical confidentiality as a last resort, based on teamwork. The law is perceived as a lever against the inertia of the victims and the justice system. Breaking medical confidentiality raises the question of who should take responsibility : ...