In October 2015, the female genital mutilation (FGM) enhanced dataset begins collecting data from GP surgeries about women who have experienced FGM. Reading the information sent to my GP surgery about this dataset,1 the correspondence in the BMJ,2 the BJGP,3,4 and online,5 I am concerned about the requirement to submit personal information about my patients without their consent, and managing my fair processing requirements.
Mostly though I find myself wondering how this conversation will be experienced on the clinical front line.
For many of the women I see in my GP surgery, when I ask about whether they have experienced FGM (been ‘cut’ down there, or closed), it may be the first time they have spoken about it to a doctor. I am mindful that I need to be aware of the possible psychological and physical sequelae of FGM, including pain, depression, and PTSD. Furthermore, I am aware that many have had complex, often harrowing journeys to the UK. I aim to establish a trusting patient–doctor relationship, before embarking on this conversation.
The Bristol PEER study found that ‘from the discussions with the women, it was clear that confidence and trust in the health services was minimal’6 and that ‘most of them felt discomfort in confiding in their doctors especially on such a sensitive issue such as FGM’.6 When, during this sensitive and difficult process, do I mention the dataset? Before I ask her to describe an event that has usually impacted hugely on her throughout her life, from childhood to adulthood, marriage to motherhood? Or do I wait until she tells her story, then thank her and inform her that I now need to talk about informing HSCIC? Can I put myself in her shoes and try to imagine this conversation? What might it mean for her? And how will I feel as a health professional having to discuss this?
It seems inevitable to me that clinicians and women will respond to this government requirement by neither asking nor telling, so avoiding a difficult situation. However, this would counter the efforts made to encourage FGM disclosure, and reduce the opportunities to offer support to women or safeguard their children.
We must reflect on the conversations we will need to have: will this help tackle FGM?
Footnotes
Conflict of interest
GP member of Oxfordshire FGM operations group/GP lead for FGM. Co-recipient of a small grant undertaking a pilot project in co-designing research into experiences of FGM.
REFERENCES
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