Ethics · Advanced · Ethics

Disclosure of Domestic Violence

Practise this PLAB 2 ethics station on Domestic Abuse. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are a FY2 working in a GP clinic. Mrs Maureen Bell, a 36-year-old woman, has come in for a routine blood pressure check. As you chat with her during the consultation, you notice old bruising on her arms and she seems anxious and withdrawn. When you gently ask if everything is okay at home, she looks tearful and starts to disclose that she is in an abusive relationship. She is scared and unsure what to do. Please take a sensitive history, demonstrate appropriate safeguarding concerns, and discuss options for support and safety planning.

Background notes: PMH: Anxiety (not formally diagnosed), sleep disturbance, chronic stress, history of recurrent injuries

What this station tests

  • Responding with belief and validation: 'I believe you, this is not your fault'
  • Safety assessment: immediate danger, escalation pattern, threats to kill, children's safety
  • Safe documentation: not on front of notes, safe coding, checking if phone is monitored
  • Not pressuring action: offering support and information without demanding she leave
  • Safeguarding duty for children: non-negotiable but handled sensitively

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself. Establish the ethical issue and your role.
  • 1-3 min — Explore Perspective: Listen to patient/relative perspective. Understand their reasoning and concerns.
  • 3-5 min — Ethical Framework: Apply ethical principles: autonomy, beneficence, non-maleficence, justice. Reference relevant guidelines (GMC, Mental Capacity Act).
  • 5-7 min — Negotiate and Plan: Find common ground. Explain your professional obligations. Involve MDT where appropriate. Document plan.
  • 7-8 min — Closing: Summarise agreed position. Outline next steps. Offer further discussion.

Consultation approach

The opening

A patient disclosing domestic violence during a routine appointment requires immediate safety assessment, careful documentation, and support without pressuring action. Mrs Bell is 36, attending for a BP check, with bruising she initially attributes to a fall. She discloses her husband is violent. Open with a safe space: 'Mrs Bell, I notice some bruising. Can you tell me how you got these?'

Core approach

When she discloses: respond with belief and validation. 'Thank you for telling me. I believe you. This is not your fault.' Do not express shock or judgment. Do not ask 'why don't you leave?' (this implies she is responsible for the situation).

Safety assessment. 'Are you safe right now?' 'Are the children safe?' 'Is he likely to come here?' 'Has the violence been getting worse?' 'Has he ever threatened to kill you or the children?' DASH (Domestic Abuse, Stalking and Honour-Based Violence) risk assessment if trained. Escalating violence, strangulation, and threats to kill are the highest-risk indicators.

Document carefully using her exact words. Record injuries with body maps. Do not include domestic violence on the front of notes or in letters that he might see. Use a safe coding system. Check: can she receive calls/texts? Is her phone monitored?

Closing and safety netting

Offer support without pressuring action. 'You do not have to do anything today that you are not ready for. But I want you to know that help is available when you need it.' National Domestic Abuse Helpline (0808 2000 247, 24-hour). Local women's refuge information. MARAC (Multi-Agency Risk Assessment Conference) referral if high risk.

If children are at risk: safeguarding duty applies. 'I have a duty to make sure your children are safe. I may need to involve children's services, but I want to discuss this with you first.' This is non-negotiable but should be handled sensitively. Safety plan: safe word with a friend, packed bag, emergency money, important documents accessible. Follow-up: safe contact method arranged.

How examiners mark this station

Examiners will assess your ethical reasoning and interpersonal skills. Domain 2 (Clinical Management) is primary: marks for applying an ethical framework, referencing relevant legislation and guidelines, and reaching a reasoned position. Domain 3 (Interpersonal Skills) is equally weighted: marks for non-judgmental exploration, empathic communication, and negotiation skills. Domain 1 (Data Gathering) assesses your ability to fully explore the situation before forming a view.

Domain 1 (Primary focus)

Scores well: Injuries documented with body maps. Safety assessed. Escalation pattern identified. Children's safety checked. Phone safety checked.

Costs marks: Not documenting. Not assessing safety. Not checking children.

Domain 2 (Primary focus)

Scores well: Helpline provided. Refuge information. MARAC if high risk. Safeguarding if children at risk. Safe documentation. Safety plan discussed.

Costs marks: No support resources. Not considering safeguarding. Unsafe documentation.

Domain 3 (Primary focus)

Scores well: Believing and validating. Not judging. Not pressuring. Empowering with information. Safe contact method.

Costs marks: Judging. Pressuring to leave. Asking 'why don't you leave?' Not believing.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate ethical reasoning or application of relevant guidelines

Fix: Structure your response around the four ethical pillars (autonomy, beneficence, non-maleficence, justice). Reference specific guidelines (GMC, Mental Capacity Act) where relevant.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Acknowledge the emotional weight of the situation early. Show that you understand why this is difficult before applying ethical reasoning.

Common mistakes in this station

  1. Asking 'why don't you leave?': implies she is responsible for the violence
  2. Pressuring her to report to police: she may not be ready and forcing action can increase danger
  3. Not assessing children's safety: if children are at risk, safeguarding referral is mandatory

Resitting PLAB 2?

If you have found ethics stations difficult, focus on learning a clear ethical framework (the four pillars) and practising how to apply it conversationally rather than reciting principles. Examiners reward candidates who can explore the tension between competing ethical principles while remaining empathic and non-judgmental.

Example opening

Thank you for coming in to speak with me. My name is Dr [Name]. I understand there is something important we need to discuss. Could you tell me your understanding of the situation?

Frequently asked questions

How should I approach this domestic abuse ethics station in PLAB 2?

A patient disclosing domestic violence during a routine appointment requires immediate safety assessment, careful documentation, and support without pressuring action. Mrs Bell is 36, attending for a BP check, with bruising she initially attributes to a fall. She discloses her husband is violent.

What are examiners marking in this domestic abuse station?

Marks are won for: Injuries documented with body maps. Safety assessed. Escalation pattern identified. Children's safety checked. Phone safety checked. Marks are lost for: Not documenting. Not assessing safety. Not checking children.

What is the most common mistake candidates make in this domestic abuse station?

Asking 'why don't you leave?': implies she is responsible for the violence. Another frequent error: Pressuring her to report to police: she may not be ready and forcing action can increase danger.

How do I prepare for this station if I have not managed domestic abuse in clinical practice?

Structure beats experience here. Focus on safety assessment: immediate danger, escalation pattern, threats to kill, children's safety. Work through the consultation approach above, then rehearse it aloud under the 8-minute time pressure so the structure holds up in the exam.

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