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At the heart of general practice since 1960

Reacting to the claim you fancy a teenage girl

Case history

Three GPs discuss a difficult practice problem

Anna, 15, and Sally, 14, are the oldest of their Polish parents' nine children. Their mother is a downtrodden-looking woman who does not speak English, and their father is unemployed, prone to medically unexplained symptoms, and perpetually nursing a grievance against the Benefits Agency.

Although their younger siblings are infrequent consulters, Anna and Sally have been attending at least once a week for the past three months, and they always attend together.

Their pretexts for attending are generally trivial. They tend to be restless and giggly.

More recently, they reported that Sally was having irregular, heavy periods. She denied (with apparent amusement) the possibility of pregnancy or the need for contraception. Abdominal examination was unremarkable and you took a blood sample from her.

They look at one another, then Anna exclaims: 'Is it true that you fancy Sally, doctor? That's what she's told our dad and the social worker who came to our house because we won't go to school.'

Dr Alex Williams is a full-time partner at a research practice in Exeter; he completed his VTS in 1990 and has been a GP trainer since 1995 ­ he is a hospital practitioner in respiratory medicine

'Should we be seeing unsupervised minors

at all?'

My initial concern would be that consulting with two minors is probably not appropriate and it would be essential for all future consultations to be with one of their parents present or the practice nurse if any examinations are required.

The immediate response would be to refute any allegations of an inappropriate relationship and to explain the high regard in which the doctor-patient relationship is held by the profession and its governing bodies such as the GMC. It may be difficult to put this across without appearing either defensive or paternalistic, but it should be attempted ­ it certainly provides a challenge of 'thinking on one's feet'.

Next comes the trickier task of what to do next? It would be essential to have an early conversation or meeting with the social worker to discuss this family in more detail. Perhaps a multidisciplinary meeting involving the health visitor, school nurse or representative and social services should be convened to share concerns.

I would want to make contact with my defence organisation to ask for advice on how best to manage the situation.

At an organisational level, one has to question whether the practice should consider restructuring its appointment system to prevent unsupervised minors turning up at the surgery at all.

Dr Rachel Pryke - completed her VTS in 1993 ­ she is now

a part-time principal in Redditch, Worcestershire, and runs a woman's health clinic

'I feel that an outright rebuttal is essential immediately'

Hmm. Despite the entitlement of these girls to good, honest health care, my first responsibility lies to myself. The temptation to brush aside such a comment would undoubtedly lead to further misinterpretation of my medical interest in their presented illnesses. No! An outright rebuttal, clearly and explicitly phrased, is essential to quell this spurious and startling suggestion. The consequences of leaving the assertion unchecked could lead, in the extreme, to GMC hearings and court cases. Hence, comprehensive note-taking is vital.

After attempting to clarify my position, I would ask what had led the pair to come to this conclusion ­ I might learn something about my rapport-building skills for a start. If the answer was in any way cheeky or mischievous, I would be tempted to go for an old-fashioned telling off, reminding them that they were wasting valuable resources by using up a doctor's appointment and that telling lies could get them into serious trouble.

It could be that their domestic background has lacked simple discipline and allowed their wanton attention-seeking behaviour to run unchecked. But it is possible that my actions could have been genuinely misconstrued, particularly if there are cultural differences in their upbringing, making familiarity with grown-ups easy to misinterpret. Good communication would be required to unravel that line of thought.

The saga is further complicated by the admission that they had told not only their father, but a social worker too. Did they really? I have no option but to check. However, I would check with my defence organisation before I talked to the father ­ he might like a new grievance to pursue, and I also need guidance on the confidentiality issues.

With this more personal agenda at the forefront of my mind, I would not be in the best position to offer ongoing medical care, or to assess whether their odd behaviour may hide an underlying social or psychological problem.

Whatever the explanation, I would hope to involve other members of the primary care team instead of myself, unless I was totally reassured that the issue was fully clarified, with no malicious intent to cause trouble on the horizon.

Dr Michael Crawford - Dr Michael Crawford completed the VTS in 2001; since then he has been a locum in County Down and doing sessions in a singlehanded rural dispensing practice ­ he has a diploma in mental health from Queen's University, Belfast

'They will have to see someone else in future'

First things first. I would aim to end this consultation as quickly and courteously as possible, avoiding any response to the suggestion made.

Next, I would inform the other partners in the practice of the situation seeking their opinions on how best to handle the allegation.

I would also be well advised to consult my defence body for specific advice on this matter before taking any action.

It would be appropriate to do some groundwork speaking first to the social worker involved in managing Sally and Anna's truancy to substantiate the spread of this allegation.

It is most likely this is part of a ploy by Anna to embarrass Sally who may have expressed in strict confidence to her sister that she 'fancied the doctor' whom they had been attending on a regular basis over the past few months and this would certainly explain their frequency of consultation ­ or unfortunately, it may be something altogether more sinister.

Either way it will necessitate speaking to their father for further clarification and it would be preferable to have this conversation at the surgery in the presence of another senior member of staff, should that be practice manager or fellow partner.

The gravity of such an unfounded allegation must be expressed and, indeed, the future of the family as patients in the practice may have to be questioned, as the doctor-patient relationship may be irreparably damaged.

In future any contact with either of these girls should be with an alternative member of staff (except in the case of an emergency) and if possible with a female member of staff.

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