Anastasia Albescu
Age: 19 years old female
Full Case
Patient’s Data
Patient’s name: Anastasia Albescu
Age: 19-year-old female
Past medical history
- No known medical conditions
Drug and Allergy history
- Not currently taking any medications
- No known drug allergy
Alerts and QOFs
- Nil
Patient booked routine appointment to discuss concerns
Patient's Story (Role player’s brief)
Patient’s Story
Be slow to speak and act anxious. You have booked this appointment because you are worried about your boyfriend, who is 40 years old.
He lost his job two months ago, and since then, he has been coming home drunk and becomes physically violent, especially when you ask him not to drink. He has hit you on multiple occasions.
He also has access to your bank account and regularly uses your money to gamble. You think he may be depressed, and you’ve come today because you want help for him.
Your partner abuses alcohol but does not do drugs nor smoke and he has no history of mental health issues
Social History: You are not pregnant, and you have no children. You do not smoke or drink. You work as a cleaner and feel overwhelmed.
When asked about your own wellbeing, you explain that while your mood is okay, you do not feel happy or safe because of everything happening at home.
Idea, concerns and expectations: You think you husband is depressed and wonder if the doctor can prescribe antidepressants or some kind of medication to help your boyfriend stop drinking alcohol.
You are not looking for help for yourself, but for your partner.
If the doctor suggests involving safeguarding or social services, you respond:
“No, please don’t. He said if I ever told anyone or reported him, he would kill me.”
You should not volunteer any further symptoms or details unless specifically prompted by a direct question.
Say NO to any other questions asked outside of the details already provided in the scenario.
If the doctor is nice- accept any plan they offer
Marking Scheme
Data Gathering and Diagnosis
- Ask how long the current issues with her partner have been ongoing
- Recognise the possibility of domestic violence early in the consultation
- Ask about other forms of abuse, including Physical abuse (e.g. hitting, kicking, pushing), emotional abuse (e.g. insults, control, isolation), economic abuse (e.g. access to bank account, control of finances)
- Ask if there have been threats or intimidation, especially any threats to kill, which indicate immediate risk
- Ask if any weapons have been used, such as belts, knives, or attempts to strangle
- Ask whether her partner uses alcohol or drugs, and how frequently
- Ask about the age of the partner (to note the significant age gap and possible coercion)
- Ask if the partner has any history of mental health issues
- Take social history- Ask about her occupation and whether the abuse has affected her ability to work or cope day to day; ask sensitively about smoking, alcohol, or drug use as possible coping mechanisms
- Ask if there are any children at home, and if so: Whether the child witnesses the abuse, whether the abuse affects the child’s behaviour, school attendance, or if teachers have raised concerns
- Ask if she feels safe speaking on the phone or video call at the time of consultation
- Explore her mood, emotional wellbeing, and how the situation has impacted her mental health
- Make a working diagnosis of domestic abuse (including elements of physical, emotional, and economic abuse)
Example of explanation to patient
Anastasia, I’m really sorry that you’re going through all of this, it sounds incredibly overwhelming and painful. From what you’ve shared with me, it seems like you may be in a very unsafe situation, and I want to gently acknowledge that what you’re experiencing is likely a form of domestic abuse.
I want to be clear, no one has the right to hurt you, no matter what they’re going through, and it’s never your fault. You deserve to feel safe, respected, and supported, especially in your own home.
I can see how much you care about your partner and that you’re trying to help him, which is really kind. But at the same time, it’s important to recognise that your safety matters too, and you shouldn’t have to sacrifice your wellbeing to support someone else.
You’ve done the right thing by speaking to me today, that takes a lot of courage. There are ways we can support both you and him, but it’s vital that you’re safe first.
The first thing I’d like to suggest, if you’re comfortable, is a referral to an Independent Domestic Violence Advisor or IDVA. These are trained professionals who support people experiencing abuse and can work closely with you to create a safety plan, guide you through your options, and offer support that’s tailored to what you need.
Since you’ve said that you don’t feel safe at home, I would also like to immediately refer you to local domestic abuse support services. They can help you access safe housing and make sure you’re protected. This doesn’t mean doing anything you’re not ready for, it just opens the door to support when you need it.
I can also hear your fear, that your partner has threatened to harm you if you tell anyone. I want you to know that these threats are serious, and your safety is the most important thing right now. In situations like this, it may be the right step to involve the police, especially to protect you from further harm. If you allow me, I can help coordinate this in a way that keeps you safe and supported throughout.
If you’re thinking about leaving the relationship but feel worried about where you would go or how to manage, I can help refer you to services like Women’s Aid or the Samaritans, who can support you with things like safe accommodation, emotional support, and even help around employment.
Management
Management
- Gently explain that her situation is likely one of domestic abuse, and affirm that this is not safe or acceptable, regardless of circumstances
- Emphasise that support is available and she does not have to face this alone
- Offer a referral to an Independent Domestic Violence Advisor (IDVA) service, if she feels comfortable — they can help her plan for safety, explore options, and provide ongoing support.
- Since she feels threatened and unsafe, advise that she should contact the police (dialling 999), as threats of harm must always be taken seriously. Reassure her that, if she prefers, you can help make the contact on her behalf to ensure she’s supported.”
- If she is thinking about leaving but is worried about accommodation, offer a referral to Women’s Aid or the Samaritans, who can assist with safe housing, emotional support, and employment guidance
- Provide contact details for a local or national domestic abuse helpline for confidential support at any time
- Offer a referral to talking therapy, as experiencing domestic abuse can have a significant impact on a person’s mood, emotional wellbeing, and self-esteem.
- Advise that if she feels it’s safe to do so, she may consider encouraging her partner to seek help for his own mental health, either by text, or via a trusted friend or family member if direct conversation feels too risky
- Safety net clearly: If she feels immediately threatened or unsafe, she should call 999 without hesitation
- Reassure her that her concerns are valid and that her safety comes first
- Offer a follow-up appointment in 1 week to check on her wellbeing, ensure she remains safe, and revisit any decisions at her own pace.
Learning point from this station:
This station highlights the importance of recognising and safely managing domestic abuse, particularly in young, vulnerable patients. Abuse may take many forms, physical, emotional, psychological, and financial and patients may present indirectly, often minimising their own needs while expressing concern for the abuser.
Clinicians must be alert to red flags such as fear, control, financial dependence, and threats of harm, and provide a trauma-informed response that prioritises safety, compassion, and non-judgmental support.
Anastasia is over 18 and has capacity, which means she is legally entitled to make her own decisions, including the right to refuse help. As long as she understands the risks and implications of her choices, she cannot be forced to accept safeguarding measures. However, clinicians still have a duty to:
- Clearly safety net: advise her to call 999 immediately if she ever feels her life is at risk or if she is in danger
- Recommend she keeps essential items (e.g. passport, ATM cards, emergency cash) somewhere easily accessible, so she can leave quickly if necessary
- Offer ongoing support and non-judgmental follow-up, respecting her timeline and decisions
- Signpost to specialist services like IDVA, Women’s Aid, or helplines for confidential advice
- Offer talking therapies, as abuse can have a lasting impact on mood, self-esteem, and trust
This case also reminds clinicians to balance respect for autonomy with duty of care, and to act promptly if there is imminent or serious risk to the patient.