Case Scenarios

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The following case scenarios will help medical professionals apply what they know about domestic violence in healthcare settings to patient interactions. Read each scenario, and answer the questions below. Click “check answer” to see the possible answers.

Case Scenario One

A 23-year-old woman, Maria, presents at the emergency room with a broken wrist. She is nervous, soft-spoken, and accompanied by her 27-year-old boyfriend, Darren. When you ask Maria how her wrist broke, Darren speaks up and says “She’s so clumsy. She fell down the stairs.” You look at Maria, and after looking at Darren, she confirms that she fell down stairs. As you examine her wrist and arm, you notice bruises that look older, and Darren tells you “Doctor, we’re here for her wrist. There’s nothing wrong with her arm!”

Questions to Consider

  1. Are there any signs that the patient might be in an abusive relationship?
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  2. What might the patient be thinking about her own safety?
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  3. What information would you like to find out from the patient?
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  4. How would you proceed with this patient?
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Case Scenario One continued

You look at Maria’s wrist, and inform her that you suspect it is broken. You take Maria down to the radiology department for an x-ray. You inform Darren that due to safety concerns, he is not permitted to come to the x-ray. Darren is disgruntled, but agrees to stay behind in the room. He tells Maria not to be too long, and to come right back to the room afterwards.

Questions to Consider

  1. What fears may prevent Maria from disclosing abuse?
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  2. How would you introduce the topic of domestic violence to Maria?
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  3. Do you need to inform Maria of any mandatory reporting laws that may affect patient confidentiality?
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  4. How would you ask Maria about her injury further?
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  5. What if Maria tells you she simply fell down the stairs?
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  6. How would you respond if Maria tells you that Darren pushed her down the stairs?
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Case Scenario Two

A 45-year-old unmarried woman, Eileen, comes in to your practice for her annual checkup and exam. Before her visit, Eileen fills out the office paperwork, and checked that she was not experiencing abuse at home on her medical history form. When you talk to Eileen, she states that she’s felt tired, stressed, and has had some digestive problems lately.

Questions to Consider

  1. Eileen stated that she was not in an abusive relationship in her patient paperwork. Should you ask her in person?
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Case Scenario Two continued

You introduce the topic of domestic violence with Eileen in private, and tell her that you ask all of your patients about domestic violence because it is a public health crisis (and you let her know of any mandatory reporting requirements). When you ask Eileen if she is being hurt by anyone at home, she hesitates. You ask if anyone has been abusive, threatening, or violent towards her at home. She eventually says yes, she is being hurt by someone at home. Eileen states that her girlfriend has been threatening her, throwing objects, and yelling at her.

Questions to Consider

  1. What do you think Eileen is thinking after disclosing that she is being abused?
    Check Answer
  2. How would you respond to Eileen?
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  3. What resources would be ideal to provide Eileen?
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Answer

Most importantly, medical professionals should show support. Let Eileen know that she does not deserve to be abused and that she deserves to be safe in any relationship. Let Eileen know there are resources in the community and people who can help her.

Answer

It is very important to know your laws regarding reporting. Some states require domestic violence offenses to be reported, while others may only require certain violent crimes to be reported (e.g., gunshot wounds, stabbings). In order to maintain a positive relationship with the patient, let her know what you may have to report before you ask her about her injuries and history of abuse.

Answer

There are many ways to introduce the topic of domestic violence to a patient. Avoid assigning blame to the victim. Focus on being kind, and recognizing that abuse is a public health issue.

Answer

Maria may be feeling embarrassed, ashamed, or guilty about being a victim of domestic violence. She may feel like she has little to no support, or like she is being judged. Maria may be scared that you would judge her, or treat her with disrespect. Maria may also be worried that you would call the police or Darren would find out and retaliate.

Answer

Because Darren is in the room, you should not screen her for domestic violence at this time. Isolate the patient from her boyfriend before asking her about her injury further.

Answer

You should find a way to privately screen the patient for domestic violence, to find out if she is feeling unsafe or if she has experienced previous abuse.

Answer

Maria is nervous and shows signs of previous injuries. Additionally, Darren is staying close to her and answering questions for her. Maria also checks with Darren before answering you.

Answer

The patient has checked with her boyfriend before answering, and is possibly covering up what happened to protect herself from him, so she may be afraid of him or what he will do. She also may fear any further violence because she needed to seek help and draw attention to possible abuse.

Answer

Eileen may be feeling embarrassed, ashamed, or guilty about being a victim of domestic violence. She may feel like she has little to no support, or like she is being judged. Eileen may be scared that you would judge her, or treat her with disrespect. Eileen may also be worried that you would call the police or that her girlfriend will find out. Additionally, Eileen may be worried about how she will be perceived because she is in a relationship with a woman.

Answer

Yes. Even if the patient stated that she was not being abused on her medical history form, it’s helpful to ask in person to give the patient a chance to talk about domestic violence, and to also let the patient know that you care about her wellbeing.

Answer

First, you can ask again how she got the injury. Ask in a way that conveys compassion, trust, and honestly. Say, “Now that Darren is out of the room, is there anything you feel comfortable sharing about your injury?” You should also follow up and ask if he caused the injury.

There is a high likelihood that this is not the first injury that Darren has caused Maria. Ask Maria if Darren has hurt her, or if she has been hurt or threatened by Darren or any other partners in the past.

Answer

Most patients will be able to find support from community resources. However, understanding your community's resources is important. Certain organizations may not serve LGBT individuals, or may not be the best for LGBT people due to prejudice or homophobia within the agency. Refer your patient to LGBT friendly organizations and hotlines. See the section on "Screening for Domestic Violence in LGBT Patients" for more information.

Answer

It is important to show Maria that you care about her and her safety. Let her know that the abuse is not her fault, and she does not deserve to be abused. Let her know that there are people who can help her in the community. Provide Maria with appropriate resources, including information for emergency shelters and victim advocates. See the Resource Site for more information.

Answer

Maria may have simply fallen down the stairs. Even if you believe Maria is not telling you the truth about how she received her injury, respect her choice to not share. Do not accuse her of lying or deceiving you. If she was abused, she has reasons why she does not want to disclose the abuse. Maria may fear for her own safety. It is important to let Maria know that you are there for her if she ever needs help or would like to talk about abuse in her past or current relationship.