GP Stage 3 Simulated Consultation - Relative 2
You are an SHO in a GP practice. Your next appointment is with Sam Jones, a patient who you have seen a number of times previously regarding their IBS.
You are Sam Jones a tearful, bank clerk who has taken the day off work to see the doctor. You have been feeling increasingly sick since the morning after discovering indecent images and videos involving children on your partner’s phone. You have a 4 year old son, and are worried that he may have been subjected to abuse by your partner, although you are too afraid to ask your son. You feel partly responsible for the discovery, as your parents had advised you against marrying your partner, however you went against their wishes and proceeded to anyway. You are visibly upset throughout the consultation and require consoling. At present you are unsure what action to take if any, and would very much like the doctor to keep the information confidential.
If asked, you report that your partner works as a ‘Play Assistant’ in the Paediatric Ward at the local hospital, and is due to be working later this afternoon. He does not have a criminal record, and you have never had any similar concerns previously. You have not told anyone else about your concerns, and would very much like reassurance from the doctor that this information will remain confidential. Your son is presently at nursery, and your partner is scheduled to collect him prior to starting work this afternoon.
This case tests a candidate’s ability to provide empathy, practical solutions as well as keep the care of patients (in particular vulnerable patients) at the forefront of their mind. Good candidates will offer emotional support and reassurance as well as suggest solutions to address maternal concerns regarding the welfare of her child. Excellent candidates will realise the importance of exploring the partner’s employment and social encounters, in evaluating immediate risk. Whilst confidentiality is important, this case represents an example of where breaching confidentiality in the public interest overrides one’s immediate responsibility of confidentiality to their patient.
Potential solutions include discussing the case further with the practice safeguarding lead (in order to establish the need for wider involvement eg. police) as well as arranging a prompt follow up with Sam, and offering to discuss the matter further with her son, should this be preferred. Ensuring that Sam and her son also have a safe place to stay in the interim is also an essential requirement as well as making sure that Sam arranges the collection of her son from nursery.