Dr Stefan Cembrowicz
'Felix's bluster probably covers anxiety'
Your position as the family's GP is one of considerable privilege, and may allow you to define what is wrong, and perhaps help this family reach common ground to solve the problem.
Tactfully arrange to see the parents separately. Having defined Alice's concerns and asked about domestic violence, talk to Hugo. See what he enjoys doing. Is he being bullied at school? How is his sleep and appetite? Does he enjoy his weekends with dad?
Having gained his trust, examine Hugo, taking note of general development, and ask him how the bruises and cuts arose. Do they look accidental, self-inflicted or deliberate?
Your morning surgery may by now resemble the wreck of the Hesperus, but you need dad's perspective. His bluster probably covers anxiety. Hugo's odd behaviour has obviously touched a nerve, perhaps because of dad's own history.
Reiterate that your job is to do the best you can for Hugo. Define Felix's own concerns and try to generate mutually acceptable solutions.
Hugo may simply be an unhappy child being used as a shuttlecock by parents in conflict.
But to exclude serious problems such as childhood depressive illness, juvenile obsessive-compulsive disorder or an autistic spectrum disorder, you may need to get advice from your community paediatrician, or child and adolescent mental health service. If possible, debrief with a colleague to look after your own feelings.