Module 4: Training Materials (health sector)

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Case Studies
Case study – Injuries in the Emergency Room

Robin, a 36-year-old man, arrives at the emergency department seeking medical attention for a head injury sustained under unclear circumstances. The healthcare professional conducting the examination notices not only the head injury but also multiple hematomas on Robin’s left arm and additional bruises in various stages of healing.

Robin is accompanied by his sister, a woman who assumes a controlling role during the medical exam, answering questions on his behalf and closely monitoring the interaction of Robin with the physician. Robin avoids making eye contact and is reluctant to share any information by himself.

As the healthcare professional delves into the details of the incident, it becomes apparent that the story provided by his sister does not align with the observed injuries. Robin exhibits a submissive behaviour, and there’s a palpable fear of physical contact.

Task for reflection

(1) Reflect on the challenges associated with documenting evidence collection procedures. Consider how healthcare professionals can maintain detailed and accurate documentation while respecting patient confidentiality.

(2) What are possible indicators that Robin is experiencing DV? What would be your next steps?

(3) Explore the emotional and psychological impact of evidence collection on victims of domestic violence. Reflect on ways to provide psychosocial support, ensuring the well-being of the patient throughout the process.

(4) Robin denies havining experienced any violence. Describe the findings as Robins attending physician in the medical record using the information provided in this case study and the further information provided in chapters “Documentation in cases of domestic violence”.

Case study – Victim of domestic violence in the dental practice with pain in her jaw

Mrs. Miller, from the case study in Module 3, had several haematomas on her neck (left picture below) combined with periorbital petechiae. In addition, a mandibular fracture was diagnosed in the X-ray (right picture below).

Mrs. Miller consents to forensic documentation and also photographic documentation to preserve the evidence for a later date.

Image by James Heilman, MD – Own work

She also tells you that she has not worked for seven years, since she met her husband. “Martin told me back than that I would be better able to look after our house and that he would take good care of me anyway.” For a long time, she didn’t even realise the dependency this had created. “About a year ago, when he saw me talking to the neighbour, he got very angry. Martin doesn’t like it when I talk to other people. He says he prefers to have me to himself. For a long time, I believed that he behaved like this because he loved me so much. The other day he pushed me over so that I fell with my lower jaw on the concrete floor in the garage.”

Case study – Documentation of DV in dentistry

In your long-standing patient Amir Rossi, who has not been at your dental practice for two years, you find the following dental status picture:

  • The incisal edge of tooth 11 has broken off, making the tooth 4 mm shorter than tooth 21.
  • A haematoma on the left orbital rim (monocle haematoma), which is already yellow-brown in colour.
  • Large carious lesions mesially on tooth 36 and occlusally on tooth 27, which need to be treated.

As you suspect the presence of DV you ask your patient in a calm atmosphere privately about DV (more information on Communication) and learn that your patient has been suffering from his husband’s recurring aggression for some time.

Mr. Amir tells you that his husband Carl was in a bad mood about fourteen days ago in the evening because he lost an important customer at work. “If he is like this he doesn´t know what to do with his anger and if I make one tiny little mistake he gets very angry with me. Fourteen days ago, he didn´t like my cooking and he hit me in the face with his fist. Then he slipped and hit my jaw. He apologised immediately afterwards and said several times how sorry he felt.” He also tells you that his husband’s outbursts of anger happen often.

You then tell Amir that his husband has no right to hurt him and that this is not ok. You offer him help by providing further information about men’s refuges, help centers and anonymous hotlines. Although the patient begins to cry, he expresses his reluctance to leave his husband at the moment, believing that this recent violent outburst will be the last.

After allowing him time to compose himself, you inquire whether the patient would be comfortable with documenting the injuries in a manner that would be admissible in court, preserving the evidence in case he chooses to report the incident to the police later on. The patient consents, and you initiate photographic documentation with a scale. Given the acute pain and suspected intrusion of tooth 11, you additionally take an impression and capture a dental film to assess the periodontal gap.

Further information

Further information on child abuse and neglect guideline: