Domestic Abuse Question
A 29-year-old woman is seen in the emergency department for a broken ankle. She describes a fall down her stairs at home earlier that day. She denies any alcohol or drug use at the time. She has no significant past medical history, but she has been admitted to the hospital many times for previous fractures and she has been seen in the emergency department on multiple occasions for various lacerations and minor injuries. The patient explains that all these visits are due to her "active lifestyle" and her frequent home repair projects. The patient has been married, she claims happily, for 2 years. She is employed as a manager at a local restaurant; her husband is unemployed and on disability pay for back problems. The patient is admitted to the hospital and undergoes successful open reduction and internal fixation for her ankle. She is able to give a more detailed history about her social situation. She describes feeling very depressed lately and having had an argument with her husband the morning of her injury. Domestic abuse is suspected. Which of the following is the most appropriate initial step in addressing this concern?
A. Address the concerns with her husband directly
B. Ask her to offer more details about the nature of her relationship with her husband
C. Explain to her that her marriage is obviously not having a positive impact on her life
D. Refer her case to the department of social services as obligated
E. Refer her to a psychiatrist who specializes in domestic abuse