Working with doctors Working for patients

 

Introduction

Jacquie has come to her regular session with Dr Clifford, a specialist in substance abuse. While she had been making good progress for several months, the situation now seems to have deteriorated and she has begun using heroin again. She is over an hour late for the appointment and says she has been unable to get her five year old son to school on a number of occasions.

(The story so far...)

Jacquie, 23, is a single parent who is in treatment for heroin addiction

Jacquie

Jacquie

Everything's gone wrong. Mum and I had a row and we're not speaking, so she's not helping out with Olly and...I'm just exhausted. Sometimes I haven't had the energy to get up and get him to school on time. But surely it's not the end of the world if he misses a day or two.

Dr Clifford

Dr Clifford

What do you do with Olly if he's not in school? Don't you think that school might be a better environment for him than at home with you if you're not doing so well at the moment? Jacquie, perhaps it's time we thought about involving social services again. That might take the pressure off you a bit so you can get back on track with your treatment.

Jacquie

Jacquie

God, no I don't want them sticking their noses in. I can manage - it's just a bad patch. I'll get back on track. There's really no need to involve social services.

Dr Clifford

Dr Clifford

But Jacquie I'm concerned that you're using heroin again, and the impact that could be having on your son. And if he's missing school...

Jacquie

Jacquie

Well that's my problem. Look it's only been a couple of times when Olly's asleep anyway. I don't want you to tell anyone so you can't. I can cope.

What should the doctor do...? (Select A,B or C)

A

Explain to Jacquie that whilst he understands why she does not want information to be passed on, he also has a duty to consider her son's welfare and that children's social services may be able to arrange extra support for her?

B

Make a referral without Jacquie's consent to social services because Olly is at risk of significant harm?

C

Respect Jacquie's wishes and not pass on his concerns about the care of her child as she is his patient and should be his first concern, and disclosure would adversely affect their professional relationship, perhaps irrevocably?

Dr Clifford

See what the doctor did

After speaking to the named practitioner for child protection again, Dr Clifford contacts Jacquie and manages to persuade her that social services could provide support for her and Olly. Jacquie eventually agrees that Dr Clifford can share relevant information with the local social services team. Dr Clifford telephones social services and explains that Jacquie has been having difficulties, and that Olly has missed a few days of school. He confirms this in writing the same day. The social worker confirms that an initial assessment will be made of Olly's welfare and that she will also look into what extra support could be offered to Jacquie.

References

When treating adults who care for, or pose risks to, children and young people, the adult patient must be the doctor's first concern; but doctors must also consider and act in the best interests of children and young people.
(0-18 years: guidance for all doctors, paragraph 5)

Confidentiality is important and information sharing should be proportionate to the risk of harm. You may share some limited information, with consent if possible, to decide if there is a risk that would justify further disclosures. A risk might only become apparent when a number of people with niggling concerns share them. If in any doubt about whether to share information, you should seek advice from an experienced colleague, a named or designated doctor for child protection, or a Caldicott Guardian. You can also seek advice from a professional body, defence organisation or the Communitybaptistpa. You will be able to justify raising a concern, even if it turns out to be groundless, if you have done so honestly, promptly, on the basis of reasonable belief, and through the appropriate channels.
(0-18 years: guidance for all doctors, paragraph 60)

Your first concern must be the safety of children and young people. You must inform an appropriate person or authority promptly of any reasonable concern that children or young people are at risk of abuse or neglect, when that is in a child's best interests or necessary to protect other children or young people.26 You must be able to justify a decision not to share such a concern, having taken advice from a named or designated doctor for child protection or an experienced colleague, or a defence or professional body. You should record your concerns, discussions and reasons for not sharing information in these circumstances.
(0-18 years: guidance for all doctors, paragraph 61)

26. A patient may no longer be in danger and request that you do not share information about past abuse, for example. Disclosure might still be justified if the abuser remains a risk to other children

Whether or not you have vulnerable adults or children and young people as patients, you should consider their needs and welfare and offer them help if you think that their rights have been abused or denied.
(Good Medical Practice, paragraph 27)

When discussing your concerns with parents, you should explain that doctors have a professional duty to raise their concerns if they think a child or young person is at risk of abuse or neglect. You should explain what actions you intend to take, including if you are contacting the local authority children's services. You should give the parents this information when you first become concerned about a child's or young person's safety or welfare and throughout a family's involvement in child protection procedures.
(Protecting children and young people, paragraph 21)

You must tell an appropriate agency, such as your local authority children's services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.
(Protecting children and young people, paragraph 32)

 
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