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A parent's lifestyle choice

Case study: What should Dr Pai do when a parent’s lifestyle choices become a cause for concern about a child or young person’s well-being?

Dr PaiMrs Smith, a single mother who is 42 years old, comes into her GP surgery to see Dr Pai. She has lost some weight, has been finding it hard to concentrate at work and has been having bad headaches.

Dr Pai asks about her diet and she explains that she has started her family on a new healthy eating regime after reading an article that said people who avoid foods containing protein and carbohydrates live longer. She tells the doctor that she now prepares meals for herself and her two young children, who are aged five and seven years, using predominantly green vegetables.

Dr Pai explains to Mrs Smith that protein and carbohydrates are central parts of a healthy diet and tells her that cutting out these food groups is likely to have been a factor in her weight loss, poor concentration and headaches. Dr Pai asks Mrs Smith about the effects of the family’s new diet on her children. Mrs Smith avoids answering the question directly and instead tells Dr Pai that the latest research says that the new diet will extend the lives of her children by ten or 15 years.

Dr Pai suggests that she sees a dietician, who would be able to give advice on diet and nutrition for the family, but Mrs Smith refuses, saying that she does not need advice. When Dr Pai tries to encourage Mrs Smith, she becomes upset, telling the doctor that it is up to her how she chooses to feed her family and she leaves the surgery abruptly.

Dr Pai is worried about the effects of the extreme diet on Mrs Smith and her young family. He is also concerned about Mrs Smith’s attitude to food, and her unwillingness to engage in discussion.

In paragraph 3 of Protecting children and young people: the responsibilities of all doctors, we say that identifying signs of abuse or neglect early, and taking action quickly, are important in protecting children and young people. A doctor must act on any concerns they have about the safety or welfare of a child or young person.

We also acknowledge, in paragraph 9, that it may be difficult to identify where parent’s freedom to bring up their children in line with their beliefs becomes a cause for concern about a child or young person’s well-being.

In paragraph 8, we say doctors should work with parents and families, where possible, to make sure that children and young people are receiving the care and support they need. Good communication with parents is essential. In paragraphs 20–22 of the guidance, we say that doctors should normally discuss any concerns they have about the safety and welfare of a child or young person with their parents. Being open and honest with families, and avoiding judgemental comments or allocating blame, can encourage families to cooperate and help children and young people stay with their families in safety.