What is the most appropriate action to take for a female patient with bruises, potential domestic violence victim, who is afraid to leave her abusive relative?

Management of Domestic Violence Victim in Clinical Setting

The most appropriate action is to provide medical management for her injuries and refer her to social services (Option A), as this approach addresses both her immediate medical needs and connects her with specialized resources to help her safely navigate leaving an abusive relationship when she is ready. 1

Immediate Medical Management

• Treat all physical injuries as the priority, documenting the extent and pattern of bruising through detailed physical examination, photographs if possible, and body maps for potential forensic evidence. 2, 1
• Assess for additional injuries beyond the visible bruises, as domestic violence victims often present with injuries to the face, skull, eyes, extremities, and upper torso, with 28% requiring hospital admission and 13% requiring major surgical treatment. 3
• Screen immediately for suicidal ideation, self-harm behaviors, and homicidal ideation, as domestic violence survivors have significantly elevated rates of depression and self-harm. 4

Safety Assessment

• Directly ask about immediate safety concerns: whether she has been threatened, whether she is afraid, and whether the perpetrator has access to weapons or a history of violence. 1
• Recognize that she has already disclosed abuse, which indicates some readiness to discuss the situation, even if she is not yet ready to leave. 5
• Understand that her fear of leaving is a realistic assessment of danger—domestic violence often escalates when victims attempt to leave, and coercion, control, and social isolation are hallmarks of domestic abuse. 2

Mandatory Reporting and Documentation

• Report to appropriate authorities as legally required in your jurisdiction, even if the patient does not want it reported, as healthcare providers have mandatory reporting obligations for domestic violence. 1
• Document all findings thoroughly, including her initial explanation of "slipping" followed by disclosure of abuse, as this pattern is typical and legally significant. 2, 1
• Note that reporting to police (Option C) without providing medical care and support resources would be inadequate and potentially harmful. 1

Social Services Referral

• Refer immediately to social services or domestic violence advocacy programs, as these specialized resources provide safety planning, shelter options, legal advocacy, and counseling that physicians cannot provide alone. 2, 1
• Provide telephone numbers of local crisis centers, shelters, and protective service agencies, ensuring she has this information in a safe format that won't be discovered by the abuser. 2
• Recognize that victims often require multiple contacts with support services before they are ready to leave—86% of domestic violence victims have suffered at least one previous incident, and 40% have previously required medical care for abuse. 3

Why Other Options Are Inappropriate

Option B (Talk to Her Relative) Is Dangerous

• Never confront the abuser directly, as this violates patient confidentiality, escalates danger to the victim, and removes her control over the situation. 2, 5
• Perpetrators of domestic violence do not usually perceive that they have a problem, and no change in their behavior is possible unless they want to change—physician intervention with the abuser is ineffective and potentially lethal for the victim. 6

Option C (Ignore and Report to Police) Is Inadequate

• Reporting alone without medical treatment and social service referral fails to address her immediate medical needs and leaves her without support resources. 1
• This approach treats the physician as merely a reporting mechanism rather than a healthcare provider and advocate. 2

Option D (Respect Privacy and Do Only What She Wants) Is Insufficient

• While respecting patient autonomy is important, physicians have legal obligations to report domestic violence and ethical obligations to provide information about resources even if the patient is not ready to use them immediately. 1, 7
• Doing "only what she wants" may mean providing no intervention if she is too afraid to ask for help, which fails the physician's duty to act as an agent of change and empowerment. 5, 6

The Physician's Role as Empowerer, Not Problem Solver

• Change your role from problem solver to listener and empowerer, allowing the survivor to make informed choices rather than dictating what she should do. 5
• Understand that victims traverse many stages of behavioral change, and she may not be ready to leave immediately—this does not mean intervention has failed. 5
• Raise her self-esteem and provide information so that she is able to alter her situation herself when she is ready. 6

Follow-Up Care

• Arrange follow-up within 1-2 weeks to reassess injuries, evaluate mental health functioning, and determine need for additional psychological counseling. 1
• Recognize that effective management involves ongoing support even if she chooses not to leave the relationship immediately—physicians must remain caring and supportive as she works through these crises. 8
• Provide trauma-informed care acknowledging the psychological impact, as victims are at risk of repeat injuries and psychosocial trauma. 1

Common Pitfalls to Avoid

• Do not discharge her without intervention directed toward prevention of future battering, as treating only the physical injuries while ignoring the underlying domestic violence is inadequate care. 9
• Do not express frustration if she is not ready to leave—understand that financial concerns, fear, and lack of social support are realistic barriers that decrease women's chances of leaving abusive relationships. 2
• Do not assume that because she disclosed abuse she is ready for all interventions—provide information and resources while respecting her timeline for action. 5