A 21-year-old woman attends her GP to renew her oral contraceptive prescription. The patient would like to try an intrauterine device but indicates that there may be issues with inserting it due to previous female genital mutilation (FGM). She says she has never discussed this with anyone before and becomes visibly upset. She tells you it was done during early childhood in her home country by a relative who has since passed away.

Which of the following is the most appropriate response to the situation?

Options:
explanation: It is inappropriate to contact the police on the emergency line as there is no imminent threat of harm to the patient. She is also an adult who should consent to you notifying the police. If they want the police to be notified, it is advised that cases are reported using 101.
name: Contact the police immediately on 999
label: b
answer: no
explanation: The patient is not a child and there is no mention of a particular vulnerability or other relatives at risk. Therefore, it would be best to explore this with the patient and then notify if there were any concerns. It would be most suitable to discuss whether she would want any psychological support and refer to gynaecology if they have experienced any physical complications from FGM, for example, incontinence, painful menstruation and frequent urinary tract infections.
name: Refer to safeguarding team
label: d
answer: no
explanation: This patient is a competent adult and there is no apparent immediate risk to others or legal obligation to break her confidentiality. Therefore, one should only offer to contact the police and respect her wishes if she chooses not to. It is advised that FGM, which is illegal, should be reported to the police; however, in an adult patient (over 18), this should be done with her consent. In a patient less than 18 years of age (ie. a child), it is a legal duty to contact the police via 101 to disclose this information and you are therefore allowed to break confidentiality in this case. As ever, if breaking confidentiality, it is important to inform the patient of this and the rationale, that is, a legal obligation.
name: Offer to contact the police
label: a
answer: yes
explanation: This patient is a competent adult and there is no apparent immediate risk to others or legal obligation to break her confidentiality. Therefore, one should only offer to contact the police and respect her wishes if she chooses not to. It is advised that FGM, which is illegal, should be reported to the police but in an adult patient (over 18), this should be done with her consent. In a patient less than 18 years of age (ie. a child), it is a legal duty to contact the police via 101 to disclose this information and you are therefore allowed to break confidentiality in this case. As ever, if breaking confidentiality, it is important to inform the patient of this and the rationale, that is, a legal obligation.
name: Contact the police immediately on 101
label: c
answer: no
explanation: Examination at this moment would provide little added useful information and may potentially cause unnecessary distress in the context of a first disclosure. It is sensible to examine the patient at one point, with a chaperone present, to determine the extent of the injury and guide further management but this is usually within an expert setting.
name: Ask to examine the patient
label: e
answer: no

Correct answer: a


Learning point: Healthcare professionals must report suspected cases of female genital mutilation in under-18s to the police within 28 days of discovery.