Patient presents with unexplained bruises, whiplash injuries consistent with shaking, areas of erythema consistent with slap injuries, lacerations, burns or multiple injuries in various stages of healing. Note that it can be very easy not to examine, for example, first generation Asian women properly because of their apparent shyness and because of the sometimes unfamiliar nature of their clothing. Patient presents evidence of sexual abuse. Extent or type of injury is inconsistent with explanation by patient. Substantial delay exists between time of injury and presentation for treatment.
Patient describes the alleged 'accident' in hesitant, embarrassed or evasive manner.
Review of medical record reveals that patient has presented with repeated 'accidental' injuries. Partner accompanies patient, insists on staying close to patient and answers all questions. Domestic violence often begins with the first pregnancy. Patient has history of miscarriage. In the USA, domestic violence accounts for one in four suicide attempts by women.