Module 5: Training Materials (health sector)

In module 4, you read the case study of Robin, a 36-year-old man, who arrived at the emergency department with a head injury and multiple hematomas on his left arm, as well as bruises in various stages of healing. He was accompanied by his sister, who assumed a controlling role during the examination, answering questions on his behalf and closely monitoring interactions with the physician. Robin avoided eye contact and appeared hesitant to share information independently.

Further inquiry revealed inconsistencies between the story provided by Robin’s sister and the observed injuries. Robin displayed submissive behaviour and exhibited a palpable fear of physical contact. These signs raised concerns about potential domestic violence. During a private conversation with the attending physician, Robin opens up and begins to talk:

Doctor: Robin, I want you to know that you’re in a safe space here, and anything you tell us will be kept confidential. It’s important for us to understand the full picture so we can provide the best care for you.

Robin: (after a pause) Well, um, actually… I’ve been having some problems at home.

Doctor: I’m sorry to hear that. It’s not easy to talk about, but it’s important to address these issues. Are you feeling safe at home?

Robin: (shakes his head) Not really. I’m afraid things might escalate.

Doctor: Okay, thank you for sharing that with me. We’re here to support you. Let’s talk about some safety planning strategies we can put in place to help keep you safe. Have you thought about where you could go if you need to leave the house quickly?

Robin: (nods) Yeah, I have a friend I could stay with for a while.

Doctor: That’s a good start. It’s important to have a plan in place so you know where to go if you need to leave quickly. Next, let’s talk about who you can reach out to for support. Do you have someone you trust, like a friend or family member, who you can confide in?

Robin: Yeah, I can talk to my brother.

Doctor: That’s great. Having someone to talk to can make a big difference. Now, Robin, I need to ask you some questions to better understand what happened. Can you tell me about the events leading up to your injuries?

Robin: Um, it’s kind of complicated. I got into an argument with my sister, and things escalated…

Doctor: I see. Can you tell me more about the argument? Was there any physical violence involved?

Robin: Yeah, my sister got angry and started hitting me. It’s not the first time it’s happened.

Doctor: I’m sorry to hear that, Robin. It’s important for me to understand the frequency and severity of these incidents. How often does this kind of violence occur, and have you sustained any injuries in the past?

Robin: It’s been happening on and off for a while now. Sometimes it’s just yelling, but other times it gets physical. I’ve had bruises and cuts before.

Doctor: Thank you for sharing that with me, Robin. It’s crucial for us to assess the level of risk you’re facing and determine the appropriate support and resources. Are there any specific triggers or patterns that seem to lead to these incidents?

Robin: It’s hard to say. It’s like walking on eggshells sometimes. Anything can set my sister off.

Doctor: I understand. It sounds like you’re dealing with a lot of stress and uncertainty. I want you to know that you’re not alone, and there are people who can help you navigate through this difficult situation. Have you considered reaching out to any support services or counseling resources in the past?

Robin: Not really, but I’m open to it.

Doctor: That’s good to hear, Robin. I can provide you with information about local support services and counseling options that specialise in domestic violence. It’s essential to have a support system in place as you navigate through this challenging time. Would you like me to connect you with these resources?

Robin: Yeah, I think that would be helpful.

Doctor: Okay, I’ll make sure to provide you with that information before you leave today. In the meantime, if you have any questions or concerns, please don’t hesitate to let me know. Your safety and well-being are our top priorities.

Tasks for reflection:

(1) Think about the safety planning strategies discussed by the doctor. Evaluate their effectiveness in empowering Robin to take steps to protect himself from further harm.
(2) Consider the doctor’s use of open-ended questions to encourage Robin to share his experiences. Reflect on how this approach helps to uncover important details about the situation.
(3) Evaluate the importance of assessing the frequency and severity of domestic violence incidents in determining the level of risk faced by the victim. Consider how this information informs the development of safety plans and access to support services.

You already met Mrs. Miller in module 3 and module 4.

We recall that she came to the dental practice because of toothache. During treatment, the dentist noticed several haematomas and periorbital petechiae. When an X-ray was taken, a fracture of the jaw was also diagnosed. Mrs Miller subsequently agreed to the forensic documentation and explained how the injuries had occurred. As the treatment of the broken jaw included several treatment and check-up appointments, Mrs Miller built up a relationship of trust with her dentist.

When Mrs Miller came for her final check-up several months later, the dentist noticed new injuries. She documents the new injuries and uses them as an opportunity to talk to Mrs

Dentist: “Mrs Miller, how are you doing? A few months ago, we had talked about your situation at home. Is everything better at home now? I can see new injuries on your ear and forehead.”

Mrs Miller (hesitating): “It’s… complicated. The situation hasn’t really improved. The arguments with Martin keep coming back.”

Dentist: “I’m sorry to hear that you’re still having issues at home. Are there circumstances that seem to trigger the violence?”

Mrs Miller: “Yes…Martin always gets angry when I try to make contact with others, whether I’m talking to our neighbour or on the phone.”

Dentist: “What happens when your partner gets angry?”

Mrs Miller: “He can no longer control his own anger and sometimes gets violent.”

Dentist: “Has he been getting angrier and angrier more often recently and are the outbursts of anger becoming more violent?”

Mrs Miller: “Yes, when I think about it… it’s been happening more often recently. It’s getting more violent too… He even threw a plate at me once and it gave a big bruise in my face.”

Dentist: “I’m worried about you, because from what you’ve told me, the frequency and extent of the violence against you is increasing. Do you have a trusted person you can talk to?”

Mrs Miller: “After I had moved to another house, I lost contact with almost all my friends and family. I only speak to my sister regularly on the phone, for example when Martin is at work. She lives 30 minutes away from here.”

Dentist: “That’s good to hear. I would now like to talk to you about what you can do if you no longer feel safe at home. It is important that you have a place where you can go if the situation escalates. This could be your sister, for example. You should also consider leaving a rucksack with copies of your most important documents, such as your birth certificate and passport, with her.”

Mrs Miller: “I have to let that sink in first, because I don’t feel unsafe at home at all. Martin just gets very angry with me sometimes and it’s always my own fault.”

At the end of the conversation, the dentist emphasises once again that it is never okay to hurt someone else, even if you are angry, and that Mrs Miller is not to blamed for the situation. She tells her that it is very important to think about where she could go if she gets scared at home and that Mrs Miller can contact her at any time with further questions. She gives her a special business card, which contains important telephone numbers for such situations (more information in module 3).

Tasks for further reflection:

(1) What communication strategies does the dentist use?
(2) What specific risk factors can the dentist identify that might point towards a further increase in the severity of violence?
(3) Why is it important for dentists to have skills in risk assessment and safety planning?
(4) How could the dentist continue to help her patient?