What are the key indicators of domestic violence and abuse that I should look for during a patient consultation?

During a patient consultation, key indicators of domestic violence and abuse to look for include:

• Physical injuries that are inconsistent with the explanation provided, or recurrent injuries ¹. For example, injuries that are more than expected from a reported fall may suggest someone else caused them ¹.
• Behavioural and emotional indicators, which can include signs of distress or changes in behaviour ⁴. These may sometimes be linked to past trauma, including domestic violence ⁴.
• Symptoms or concerns linked to stressful relationships or violence at home ¹. Patients may present with symptoms that they attribute to, or that could be triggered by, such events ¹.
• Expressions of fear or feeling unsafe in their relationship or at home ¹. This can be identified by asking direct questions such as, 'Do you feel safe at home?' or 'Is there anything that worries you about your relationship?' ¹.
• Evidence of different forms of abuse, including physical, sexual, psychological, or financial abuse, especially when perpetrated by someone personally connected to the patient ⁴.

To help identify these indicators, it is crucial to:

• Ensure privacy: Allow the person to make a disclosure alone in private, without any third parties present ¹,³.
• Ask sensitively: Use kind, sensitive questioning and gender-neutral terms like 'partner/ex-partner' ¹,³.
• Utilise open and direct questions: Consider open questions like 'How are things at home?' or 'We know violence at home can be a problem, is there anyone who is hurting you?' ¹. Direct questions such as 'Does anyone make you feel afraid?' can also be effective ¹.
• Consider routine enquiry: In certain services, such as antenatal, postnatal, sexual health, alcohol or drug misuse, and mental health, asking about domestic abuse should be a routine part of good clinical practice, even if no specific indicators are immediately apparent ³.