2. What you might see — including domestic abuse

In the surgery

• Injuries to the head and neck that do not match the history, or that the patient will not explain with a partner in the room
• A carer who insists on staying for every appointment and answers every question
• Missed appointments and untreated pain while a relative controls the diary and the money
• A patient who looks to the other person before saying yes to treatment
• Sudden change in appearance, hygiene or engagement in someone who used to cope
• Requests to change records or to “not tell mum” that sit uncomfortably

Domestic abuse and coercive control

This is not only bruises. Coercive control is a pattern of isolation, fear and domination. In practice it can look like a partner who cancels appointments, who will not leave the surgery, who mocks the patient, or who controls payment so that urgent care is delayed.

If you can, offer a moment alone (“I’ll just check medical history privately”). Have a private space. Know your local domestic-abuse helpline. Do not hand leaflets to someone while the alleged abuser is watching if that could increase risk.

Financial abuse

Watch for a third party who always pays cash from the patient’s account, who refuses a treatment the patient wants and can understand, or who pressures you to write a letter that does not match the clinical picture.

Neglect by carers and self-neglect

A dependent adult left in pain with no attempt to access care is a concern. Self-neglect in someone who has capacity is harder: you still try to engage, reduce harm, and share if the risk is serious and they cannot protect themselves, following local adult-safeguarding and mental-capacity processes.

Do not assume

Disability, old age or an accent is not evidence of abuse. You are looking at power, fear, unexplained injury, and unmet need — not at stereotypes.