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At the heart of general practice since 1960

Dr Patrick Wills

'At least Sharmaine is attending STD screens'

This may explain Sharmaine's well-dressed children, despite the master of her house currently being unavailable for his usual line of employment. If she is on the game then at least she is behaving responsibly by attending for screening for sexual infections.

My male patient may visit prostitutes. That is his business ­ but not if it involves a minor.

The real issue here is what are the risks to Marika and her three-year-old twin brothers.

Wearing suggestive clothes is not a crime, using soft drugs is commonplace in adults and kids, though obviously illegal. Encouraging a child to solicit for sex is big stuff.

They need to be challenged to explain their behaviour; I will be fascinated to hear their response.

I am, however, rushing to visit a patient with chest pain, and need to make a snap decision about what is the most important thing to do, what is really happening and what realistically I can change.

It is difficult to know whether in practice I would slink by, hiding my face behind my medical bag, agonising over the issues later, or whether I would make myself known to the little group. Shouting a cheery 'Hullo Sharmaine, Marika.... and it's Mr Bloggs isn't it?' could have an electrifying effect and may even save the situation, for tonight at least.

I don't know what to do.I need urgent advice from a number of agencies.

The designated doctor for child protection and social services should be involved. It may be appropriate to contact the police urgently. Do I have any real evidence, however? It may be that rather than any definite evidence of wrongdoing, all I have is a suspicious mind and a negative stereotype of Sharmaine and her family. Being picked up for drugs by the police would at least activate social services, even if nothing else could be proved.

It might be helpful to discuss things with my defence organisation's 24-hour helpline.

I would share the problem with partners in my practice and draw on their experience, both for the sake of trying to do the right thing for my patients and also for the necessity of talking things through for my own mental health.

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