Confessions of a GP - Benjamin Daniels [73]
Some areas have wonderful emergency social services with a team of physios, carers and social workers on call to provide urgent assessments and vital care to people who desperately need it. They keep people out of hospital, saving money and preventing people from catching MRSA and other hospital bugs. Unfortunately, most emergency social services teams are terribly underfunded, understaffed and suffer from low morale. They might not have a flashing blue light on their cars but they are desperately needed and would pay for themselves many times over by preventing unnecessary hospital admissions, especially at Christmas.
Aggressive conduct disorder
This is an ethical dilemma that I faced and I have no idea if I did the right thing or not. I wonder what you will think. A mother came in to see me with her 12-year-old daughter and asked for her to be put on the pill. I said no and Mum was furious.
Basically, the daughter, whom I’ll call Amy, looked more like a 15-year-old than a 12-year-old. However, she wasn’t 15, she was 12! Her mother told me that she had ‘aggressive conduct disorder’. I had never heard of this but Mum explained to me that her condition resulted in her refusing to do anything that her mum told her to do, becoming very aggressive and basically doing anything that she wanted. She sounded like a stroppy 12-year-old with no boundaries to me. The difference between Amy and most moody 12-year-olds was that every evening Amy went to the local park with some older teenagers and drank alcohol, took drugs and had sex. She also refused to go to school. Mum told me that she physically couldn’t stop Amy from leaving the house. If she tried to do so, Amy would lash out at her and start hitting her mum and smashing up the house. Mum then showed me some of the bruises on her arms to prove it. Amy was bigger than her mum and there was no dad or partner around at home for support.
As far I was concerned, a 12-year-old having sex was child abuse and indicated a need to have social services and child protection services involved. I was amazed to hear that these services were already in place with social workers, the police and child psychiatrists all involved with her care and having regular child protection meetings. Despite this, there had been no change in Amy’s behaviour. Mum’s basic standpoint was that she couldn’t stop Amy from having sex but did at least want her to avoid the trauma of having an abortion or a baby. I just couldn’t believe that Mum appeared to be so accepting of her daughter’s behaviour.
Amy herself was in the room with us but sat silently in the chair staring at the floor. I tried to engage her and ask her a few questions. I even tried to speak to her without her mum present, but I got no response whatsoever. I am allowed to prescribe the pill to under-16s but I have to be convinced that they have the ability to understand all about the pill and make the decision as to whether they want to take it or not. As Amy refused to talk to me, I couldn’t be sure of this so I felt justified in not prescribing the pill for this reason.
Amy’s mum left, annoyed. ‘Don’t judge me,’ she said as she got up and left. ‘Do you not think I’ve tried everything I can to help and protect Amy? I love my daughter.’ It was too late. I had judged her. I feel that a parent must be able to physically prevent their 12-year-old daughter from having sex, getting drunk and taking drugs. Maybe my opinion will change if I ever have a teenage daughter. I’m not suggesting that Amy should have been taken into care and locked away, but shouldn’t there have been something more on offer from