A patient comes to see you with recurring headaches which they put down to difficulties at home
You are asked to speak to a patient who was initially reluctant to be examined but then found to have multiple bruises
A patient complains that their partner has ‘a bit of a temper’
Domestic abuse is very common and can be physical, sexual or emotional. Consequences include traumatic injury and death, and victims are more likely to suffer from chronic illness and mental health problems.
Aims of the station
Be reassuring and non-judgemental
Don’t be afraid to ask about abuse
Assess risk to patient and their children
Don’t assume the patient wants to leave their partner immediately, just offer advice and support
Before raising the issue
Develop a good rapport with the patient and make them feel comfortable
Assure them about privacy, safety and confidentiality
Ensure their potential abuser isn’t present
When raising the issue
Use an open question to allow them to explain the situation: ‘Tell me about things at home’, ‘Do you feel scared/safe at home?’, ‘I’m worried someone may have hurt you’, ‘I’m worried you may not be safe at home’, ‘Does your partner’s behaviour upset you?’
Establish the details of the abuse
Type(s) of abuse:
Physical: ‘Has your partner ever hurt you?’
Sexual: ‘Does your partner ever make you do sexual things you don’t want to?’
Emotional: ‘How does your partner make you feel? Do they belittle you or try to control you?’
Perpetrator: Who is it?, What’s their relationship?
Pattern: When does it occur? Are alcohol/drugs involved?
Timeframe: How long? Has the abuse been escalating?
Coping: How have they coped? Have they tried anything to stop it/get away?
Who else is involved: Are any children or vulnerable adults potentially at risk?
Explore their social situation/domestic environment
Who do they live with?
Are there weapons in the house?
Does the patient have an emergency safety plan? If not, consider trying to construct one with them and tell them they can always call the police
Do they work?
Try to be supportive, all them time to talk and offer tissues if they get upset
Be relaxed and compassionate with the patient
Don’t pressure them into telling you, but they may need to be asked several times before opening up
NEVER FORGET RISK!
From partner: Do they currently feel in danger? What would happen if they go home?
Risk of self-harm: Has it affected their mood? Have they ever considered harming themselves or taking their own life?
To others: Are any children or vulnerable adults potentially at risk?
Abuse risk factor assessment– consider the following if relevant
Victim: low self-esteem, low income, young
Partner: pregnancy, alcohol/drug use, psychiatric issues/personality disorders, unemployment, being a victim of poor parenting/abuse/physical discipline, convictions