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Christopher's father comes to the surgery to view his son's medical records. He also wants to discuss the referral with Dr Williams.

(The story so far...)

Christopher is being bullied at school because his ears stick out. At the request of Christopher's mother, Dr Williams referred him to a paediatric surgeon. Christopher's parents are divorced and his father is unhappy about the referral.

Mr Rees

Mr Rees

I just don't want Christopher to be put through pain and discomfort because of his mother's vanity. And what about the risks? I thought it was a serious thing to be given an anaesthetic.

Dr Williams

Dr Williams

Were you aware that Christopher is being picked on at school? He does seem to be rather upset about it. We need to think carefully about what is best for Christopher.

Mr Rees

Mr Rees

Everyone gets teased when they're little. He'll get over it. I don't give my consent to this operation, so it can't happen. I want you to withdraw the referral.

What should the doctor do...? (Select A,B or C)


Tell Mr Rees that Mrs Rees has already given consent for the referral and that is all that is required for her to refer Christopher?


Suggest to Mr Rees that they meet with Mrs Rees to try and resolve the issue informally?


Cancel the referral?

Dr Williams

See what the doctor did

Dr Williams arranges a meeting with both of Christopher's parents, so they can discuss whether or not Christopher's referral to have his ears pinned back should be cancelled. At the meeting it is agreed that Christopher's school should be contacted to establish the extent of the bullying before making a final decision about whether he should have surgery.


An assessment of best interests will include what is clinically indicated in a particular case. You should also consider:
a. the views of the child or young person, so far as they can express them, including any previously expressed preferences
b. the views of parents
c. the views of others close to the child or young person
...The weight you attach to each point will depend on the circumstances, and you should consider any other relevant information. You should not make unjustified assumptions about a child or young person's best interests...
(0-18 years: guidance for all doctors , paragraph 12 a-c, 13)

If providing treatment to children, you should be familiar with the detailed advice in 0-18 years: guidance for all doctors, which includes the key points set out in this section of guidance. You should take particular care if you consider providing cosmetic interventions for children or young people - you should make sure the environment for practice is appropriate to paediatric care, and work with multidisciplinary teams that provide expertise in treating children and young people where necessary.
(Cosmetic interventions, paragraph 32)

You must only provide interventions that are in the best interests of the child or young person. If a young person has capacity to decide whether to undergo an intervention, you should still encourage them to involve their parents in making their decision.
(Cosmetic interventions, paragraph 33)

A parent can consent to an intervention for a child or young person who does not have the maturity and capacity to make the decision, but you should involve the child in the decision as much as possible. If you judge that the child does not want to have the cosmetic intervention, then you must not perform it.
(Cosmetic interventions, paragraph 34)