Serious concerns

...The patient is on methadone and appears intoxicated when she attends for her appointment. Dr B is worried about her two-year-old daughter whose clothes are soiled...

A 31-year-old patient on methadone substitution therapy appears at her GP surgery along with her two-year old daughter. Calling out her name in the waiting room Dr B notices that the woman is clearly drunk. She admits as much when asked during the consultation which is for a skin infection.

Dr B finds on the patient’s records that she has been subject to a child protection order for the neglect of an older child. He notices that the little girl with her is wearing soiled clothes and jumper inadequate for the cold weather outside. Dr B grows concerned and asks the patient if she has seen a social worker in recent months. The woman becomes annoyed and tells him to mind his own business. She then grabs the young girl who begins to cry and storms out the practice.

A closer look at the patient files reveals that the patient’s current partner is also on methadone. Dr B is worried by the situation and phones MDDUS for guidance.

Analysis and outcome

The MDDUS adviser reminds Dr B that GMC guidance states that doctors play a crucial role in child protection and must always consider and act in the best interests of children and young people. The parents of a child potentially at risk may not want information disclosed about them if fearful that will mean they are denied help, blamed or made to feel ashamed. But the implicit advice to doctors is that “you must not delay sharing relevant information with an appropriate person or authority if delay would increase the risk to the child or young person or to other children or young people”.

Given the circumstances it is clear Dr B is justified in reporting his concerns to the local social work office or child protection lead and if necessary without the consent of the woman. Indeed he would be in breach of GMC regulations and liable to censure without a clear justification for not sharing his concerns.

Key points

  • Promptly inform appropriate authorities should you suspect a child may be at risk of abuse or neglect – with parental consent if possible.
  • Have a clear understanding of local child protection procedures to ensure no delay in necessary intervention.