A patient presents to the emergency room (ER) with severe physical bruises, admitted to being a victim of domestic violence by a relative, and expresses fear for her future safety, what is the best course of action?

Management of Domestic Violence Victim in the Emergency Department

You must treat the patient's injuries, involve a social worker immediately, AND report to the appropriate authorities as mandated by law—this is not an either/or situation but a comprehensive legal and ethical obligation. 1, 2

Immediate Medical Management

• Prioritize treatment of all physical injuries through thorough examination and documentation of every bruise, laceration, and trauma site, as the severity of her injuries requires immediate medical attention 2
• Perform imaging studies (X-rays, CT scans) as clinically indicated to assess for fractures, internal injuries, or head trauma given the severity of the beating 2
• Document all injuries meticulously with detailed descriptions, measurements, and photographs if available, as this documentation serves both medical and forensic purposes 2

Mandatory Legal Obligations

Healthcare providers are legally required to report domestic violence to law enforcement or protective services, even when the patient explicitly requests otherwise. 2 This is not optional—it is a legal mandate that supersedes patient preference in domestic violence cases.

• The emergency physician has an ethical duty to diagnose, treat, and report suspected victims of abuse to appropriate authorities as permitted or required by law 1
• Contact law enforcement immediately while the patient is still in the emergency department, as this ensures documentation of the incident and initiates the legal protection process 2
• Understand that your duty to report exists independently of the patient's wishes—her fear and reluctance to involve authorities is a common response to domestic violence and does not negate your legal obligation 2

Social Work Intervention (Concurrent, Not Alternative)

• Immediately involve the social worker or domestic violence advocate while you are treating her injuries—this is not an alternative to reporting but an essential parallel intervention 2
• The social worker provides specialized resources including safety planning, shelter options, legal advocacy, and counseling that physicians cannot provide alone 2
• Ensure the patient receives telephone numbers of local crisis centers, shelters, and protective service agencies in a format that won't be discovered by the abuser (such as a card disguised as something innocuous) 2

Safety Assessment

• Directly ask whether she has immediate safety concerns, whether the perpetrator has threatened her, and whether she fears for her life 2
• Assess for immediate danger by inquiring about the perpetrator's history of violence, access to weapons, and whether he knows she is at the hospital 2
• Do not allow the relative to be present during any part of the examination, history-taking, or discharge planning—his presence in the emergency department while "shouting at her" represents ongoing intimidation and control 2

Why Patient Preference Cannot Override Reporting

• Recognize that her fear about the future and desire to return home reflect the realistic danger of escalation when victims attempt to leave—domestic violence often intensifies at separation 2
• Understand that coercion, control, and social isolation are hallmarks of domestic abuse, and her reluctance to involve authorities demonstrates the perpetrator's successful intimidation 2
• Your legal duty to report exists precisely because victims are often too frightened or controlled to protect themselves—the law recognizes this power imbalance 1, 2

Common Pitfalls to Avoid

• Never discharge the patient back home without completing the mandatory report and ensuring law enforcement is involved—this places her at immediate risk of retaliation and further violence 2
• Do not express frustration if she states she wants to return home or refuses to leave the abuser—financial concerns, fear, and lack of social support are realistic barriers that decrease women's ability to leave 2
• Never allow the perpetrator's presence or demands to influence your medical decision-making or reporting obligations 1
• Do not assume that because she has "multiple severe physical bruises" this is an isolated incident—86% of domestic violence victims have suffered previous abuse, and 35% experience it daily 3

Correct Answer

The answer is A (Treat the patient and tell social worker) AND C (inform authority) simultaneously—these are not mutually exclusive options but rather complementary legal and ethical obligations that must both be fulfilled. 1, 2 If forced to choose only one answer in a multiple-choice format, Option A is technically more complete as it includes treatment plus social work involvement, but understand that informing authorities (Option C) is also legally mandatory and should occur regardless. 1, 2