Domestic violence in a health care professional

Objective: To illustrate the typical excuses of women who keep staying in an abusive relationship

Narrative case:

Nicole is 35, married for 8 years and has two young children. She works as a nurse in a hospital. She comes for an anaesthetic consultation before surgery in the day care unit. She is pretty and healthy with no past medical history of note. As part of clinical examination, she is asked to take off her blouse which has long sleeves and the scarf around her neck but she refused [1]. The female doctor tells her that without examination there is no anesthesia: she is a nurse and she surely understands this fact. She removed her clothes and it is immediately obvious why she was so hesitant: she had many bruises on her arms and around her neck as if somebody had tried to strangle her [2]. She admitted that her husband beats her “but only when he thinks that she has done something wrong”. The doctor says she can give Nicole a medical certificate describing her bruises and advises her to take it to the police station where she lives [3].  She says “I can’t do this because of my two children”. She is counselled that one day her husband will kill her and that she must think about her children’s future. She agreed and left with the certificate. One week later she came back for her anaesthetic and is asked if she has complained at the police office. She said: “No, it was too dangerous for my children but I have always got the certificate”[4]. She has not been seen again.

Learning points:

1. It is necessary to be concerned about any woman who does not want to take off her clothes for a medical examination by a female doctor. It is important to think about the fact that she does not want the doctor to discover what she wants to hide.
2. Even healthcare professionals, in this case a female nurse, can try to hide the physical findings which show she has been subject to domestic violence from a female doctor.
3. It is important to try and convince a woman battered by her husband that she has the right and even the duty (if she has children) to lodge a complaint against him. However, this is often very difficult because she feels guilty about her husband’s behaviour.  
4. Women subject to domestic violence often do not complain because they have young children and feel they dare not do this for fear of the consequences from their partner.