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Profoundly deaf patient

Case study: What should Dr Abbott do when she has difficulty communicating with a young person who may be at risk of abuse?

Dr AbbottPaul, who is 16 years old, is at a scheduled appointment with Dr Abbott at his local GP surgery. He has been on a course of antibiotics for a chest infection and has come to the surgery for a follow-up consultation. Paul lives in a rural area and has been driven to the surgery by his uncle, Roger.

Paul is profoundly deaf and communicates predominantly using British Sign Language. He can also do some lip reading but this is limited to short words and expressions. An interpreter has been booked to come to the session but, when Paul and Roger arrive at the surgery, the receptionist explains that the interpreter has been delayed and is running at least an hour late.

Roger tells the receptionist that they are both keen to get away from the surgery as quickly as possible. He explains that he has some basic skills in British Sign Language and would be happy to interpret for Paul and the doctor so they don’t have to wait for the interpreter to arrive. Paul lip reads what is being said and indicates he is happy with this idea, and they agree for Roger to interpret during the consultation.

Dr Abbott examines Paul, and finds that the chest infection has not cleared up. She prescribes a course of stronger antibiotics and asks Paul to return to the surgery in a fortnight’s time. During the consultation, she notices that Paul has some faded bruising around his face and a large scab next to his left eye. She also thinks that Paul seems subdued and looks unhappy throughout the examination.

Dr Abbott asks Paul, through Roger, how he got his bruises and cut to the eye. Roger seems uncomfortable and is initially reluctant to relay what Dr Abbott has asked Paul. After some prompting, Roger explains to the doctor that Paul had an argument with his father a few days ago and has been staying with him for a short time while they both calm down. Roger tries to play down the situation, telling Dr Abbott that this has happened before, and explains that he intends to take Paul back to his parents the following day. He implies that Paul is disproportionately upset about the argument and assures her that there aren’t any serious problems at home. He tells the doctor that his brother, Paul’s father, is a good dad but can just be a bit impatient at times.

In paragraph 5 of Protecting children and young people: the responsibilities of all doctors, we say that a doctor must act on any concerns they have about the safety or welfare of a child or young person.

In paragraph 17, we say that doctors should consider speaking with a child or young person without the parent or carer present, if that may help them to be more open about what has happened to them, or about any concerns or fears they have. In paragraph 14, we say that doctors should be able to use methods of communication that are appropriate to their patient group.