What does our guidance say?

In this particular case you’d need to more fully explore Ellen’s reasons for wanting the procedure, and the outcome she hopes to achieve. This may include for example, asking her whether she’s had a chance to speak to friends, family or her GP about this, and what she’s tried so far in terms of losing the weight she gained during her second pregnancy. By doing this, you will be able to assess whether or not the procedure is clinically appropriate and likely to meet her needs (paragraph 17).

If you decide that the procedure is clinically appropriate and likely to meet her needs then you’d need to discuss the options, including potential risks and benefits as well as the likely outcome of the procedure Ellen is seeking, making sure that Ellen’s expectations are realistic (paragraphs 22 and 23).

You must also discuss with her if there are any alternative interventions with less risk available that might meet her needs (paragraph 21).

Throughout your discussion you should be encouraging Ellen to ask any questions.

This discussion, focussing on the issues you and Ellen feel to be most significant, will allow Ellen to make an informed choice. What about Ellen’s psychological wellbeing? If following further discussion, you still think that Ellen’s responses show that she may be suffering from post-natal depression you should discuss further with her the idea of seeing a psychologist (paragraph 19) and why it is necessary to speak to her GP (paragraph 27).

What if Ellen still refuses to see a psychologist?

If this is the case, you would need to sensitively explain to Ellen that it’s in her best interests to get this assessment to ensure that any decision she makes is for the right reason. If Ellen still isn’t happy to do this, you must explain that as this kind of assessment is beyond your personal expertise, you have a responsibility to speak to colleagues about her case for advice about how best to proceed (paragraphs 44 and 45). It would be good practice to obtain Ellen’s consent to speak to colleagues about her case and to record this in her notes.

What if Ellen doesn’t want you to speak to her GP?

You should again explore the reasons why Ellen doesn’t want her GP involved. It might be helpful to explain to her the benefits of you having a conversation with her GP and the risks to her if you don’t have all the information you need.

If Ellen still refuses, you would need to record this decision in her notes and consider how this may affect the balance of risk and benefit and whether you have enough information to go ahead with the intervention.

If you decide to go ahead without contacting Ellen’s GP, after the procedure you should give Ellen written information explaining the procedure including what devices or medicines were used. You must record in Ellen’s notes that she objected to the information being shared with her GP, and you will be responsible for providing Ellen’s follow-up care (paragraph 39).

If you think that information from Ellen’s GP is essential to the provision of safe care you should explain that you can’t go ahead with the procedure Ellen wants, without a discussion with her GP (paragraph 27).

Ultimately, if you are concerned that the procedure may not be of benefit to Ellen, then you must not provide it. You should however discuss the options available to Ellen and respect her right to seek a second opinion (paragraph 18).   

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