Then the visits stopped.

A year or more passed and she came back to my office, this time without symptoms - just for a regular check up...alone. She looked different than before. Her hair and her skin were shinier. Her eyes were clear and dry. "Where is your husband?" I asked, slowly, enunciating each syllable for her benefit. "I left him," she declared, in accented but unhesitant English.

"I couldn't take him hitting me any more."

In the last decade or two there has been a quiet movement in medicine - it doesn't have a name of which I am aware - in which clinicians are urged to ask certain questions routinely, regardless of who the patient seems to be. It's a reversal, really, of the longstanding notion that a seasoned doctor or nurse's intuition about a patient will lead him or her to focus on the right problem. Now, particularly in primary care, we supplement intuition with pre-printed checklists of issues that may affect our patients' health, safety, and quality of life. This may seem mechanical, but it works. We now ask nice, middle class people about drug use, seventy year olds about sexual satisfaction, and seemingly happy couples about domestic violence.

I finished the physical and found my patient in good health. "How come you never told me he beat you?" I asked her. "Or that you spoke English all along?"

She replied, quite sensibly: "You never asked."