Wednesday, 3 June 2015

Schrodinger’s Safeguarding Case

Whether you've been practising medicine for 30 minutes or 30 years, dealing with the issue of safeguarding is one of the biggest challenges for any of us.  We are told that there are several must do’s such as:

Wait a minute...   I know the list goes on but those first two are quite enough to deal with before we process any more.  What those two statements mean in practice is that the minute I've thought of a way that this could be a safeguarding issue, I am doing mental gymnastics trying to figure out the following things: 


If this comes easily to you then you have my admiration.   For the mortals among us it is so challenging that at some point most of us have wished that there was no concern or that we didn't have to be the one that brought it up.  You have to be careful though, because when you find yourself wishing for these things you might just do something to make them happen.  It is within your power to explain the concern away.  It is possible to refer to someone else who will take your concern further without telling the parents.  Neither of these are good ‘ways out’.

The problem is that we often see the way forward as a choice or a judgement on the situation.  This choice forces us to feel as though we are choosing sides which is intuitively at odds with our instinct to be on the side of the parents.

There is a solution that I believe does work: Schrodinger’s safeguarding.   [If you don’t know about Schrodinger’s cat (a mixture of quantum physics and animal abuse that makes sense in a strange way) then don’t worry.]  The principle that I want you to get you head around is this:


In this way you can overcome all the barriers to dealing with the problem.

Because you treat the concern as fully real:
  • You will act in the best interest of the child.  You will explore the concern until satisfied.
  • You will involve all the right people.
  • You will ask all the right questions and document things in far more detail than you would normally.
  • You will tell the parents that you have a concern because you can’t do the first three things adequately without them noticing that something is going on.

Because you treat the concern as fully false you will come across differently and the parents will sense your open-mindedness:
  • You will come across as non-judgemental.   You will be able to be matter of fact about the need for the safeguarding concern to be raised and answered and they will sense that you have not judged them.
  • You will keep the health of the child as a top priority.  The parents will have come with their own agenda and you will remember to address that just as you would have normally.  This also helps parents to see that you have not de-humanised them.

So next time you have a safeguarding concern, do put it back in the box.  Not a Pandora’s box but a Schrodinger’s box.  You're not making a judgement but you do need to do both of your jobs.

Edward Snelson
@sailordoctor

Disclaimer:  Damn it Jim, I'm a doctor not a quantum physicist.

2 comments:

  1. I like this concept - thanks Edward.
    When I talk to our PEM CT3s about having the "safeguarding conversation", I suggest having a mental script ready; mine goes a bit like this.
    "There are some things about [your child]'s injuries/presenting problem that I can't completely explain - that's certainly not uncommon here. The problem is that we know that sometimes children are hurt and it isn't an accident. I am absolutely not accusing anyone of anything, but when we can't explain what's happened we have a duty to think a bit harder about what has happened. Sometimes that means we keep parents/carers a little longer than we ordinarily would but most importantly it gives us an opportunity to identify and protect those children who need it the most. So I'm sorry that we need you to stay a little longer while we ask a few more questions and maybe do some further tests, but by taking this approach to looking after children when we can't explain what's gone on we have a much better chance of ensuring we can keep as many children - including yours - safe as possible."
    I've found people rarely argue with the "greater good" concept of safeguarding which is what we are talking about employing here - in practice we are sensitive with a cost to our specificity which is certainly appropriate in the paediatric ED.

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  2. Thanks for all of that Nat. In fact you've reminded me of one of the things I do because the safeguarding concern is 'fully false'. I always apologise for the inconvenience. If you're going to do Shrodinger's safeguarding then you have to flick form one attitude to the other. When I'm in my 'this is not a safeguarding issue' frame of mind I can't help but want to apologise for the time taken and the the stress caused by the process.

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