"As it is there is little that we can do - we handed the patient over to the triage nurse and made our concerns known to her, then delegated any decision upwards by noting our concerns on one of our 'vulnerable adult' forms. I'm not sure these forms are designed for this purpose, but we do what we do and if someone in the upper rungs of management wants to throw it in the bin it's up to them.
He [sic] is the thing, we have no idea what happened - no-one was volunteering information and we are only with the patient for a few minutes so it's not really appropriate to start investigating. Did the husband do this to his wife? Was it an assault in the street that they are ashamed about? Was she trying to hit the husband and she got the bruising while he was restraining her?
Who knows, I can't judge. I'm not the police so the best we can do is draw it to someone else's [sic] attention within the confines of patient confidentiality. All I am, as one politician said, is a taxi driver with bandages. "
Unfortunately, that same sentiment of helplessness carries through to many levels of treatment. When should someone offer help? Simple domestic violence screening is often enough to get the ball rolling. Have some excuse to separate the husband and wife* and tell the patient that these injuries are often associated with domestic violence, ask her if she is safe and if she needs help. It is a non-judgemental way to open the door. With something like 1 in 4 women being abused in our society routine screening is the minimum that all health care workers should be doing.
*I realize there are always mitigating circumstances such as the language barrier in this particular situation. It was the line "as it is there is little we can do" that set me off.