Lesson 4.4: Safeguarding Children and Adults
Safeguarding scenarios appear regularly in PLAB 2. The examiner wants to see that you recognise potential abuse, know the referral pathway, communicate without falsely accusing, and act without delay.
Safeguarding Children — Red Flags for Non-Accidental Injury (NAI)
- Injuries inconsistent with the stated mechanism (e.g. 'fell off sofa' → bilateral retinal haemorrhages).
- Delay in seeking medical attention without a clear explanation.
- Changing or inconsistent account of how the injury happened.
- Bruising in unusual locations (ears, neck, buttocks) or characteristic shapes (loop marks, cigarette burns).
- Injuries at different stages of healing.
- Child appears fearful of the parent, or the parent minimises injuries or shows little concern.
The Referral Process
- Treat any injuries — ensure the child is safe first.
- Do NOT confront the parent with your suspicions — this can increase risk to the child and compromise the investigation.
- Discuss immediately with your senior (registrar or consultant).
- Make a same-day referral to children's social care (MASH — Multi-Agency Safeguarding Hub).
- Document clearly and factually — describe what you see, not what you conclude. 'Multiple bruises noted at different stages of healing' not 'child appears to have been beaten'.
- If there is immediate danger to the child, involve the police.
When speaking to parents, do not accuse. A safe, neutral approach: "I'm concerned about [child's] injuries and I want to make sure they get the best possible care. We always refer children with this type of injury to our specialist safeguarding team as standard practice. Someone from that team will be in touch with you."
FGM — Mandatory Reporting Duty
Since October 2015, registered healthcare professionals in England have a mandatory duty to report to the police if a girl under 18 discloses that she has undergone FGM, or if you believe FGM has been performed on a girl under 18. This applies even without parental consent. Failure to report is a criminal offence.
Safeguarding Adults — The Care Act 2014
An adult at risk is someone aged 18 or over who: (a) has care and support needs for any reason, AND (b) as a result of those needs, cannot protect themselves from abuse or neglect.
| Type of Abuse | Examples |
|---|---|
| Physical | Hitting, restraining, inappropriate use of medication |
| Sexual | Non-consensual sexual acts, sexual harassment |
| Emotional / psychological | Threats, humiliation, isolation, coercive control |
| Financial | Theft, fraud, misuse of benefits, pressure to change a will |
| Neglect | Failing to provide food, warmth, medication, or access to services |
| Domestic violence | Abuse by a partner or family member — can affect any adult |
| Self-neglect | Failing to care for one's own health or safety — triggers a safeguarding review |
Domestic Violence — How to Ask
Create a private moment first — ask a carer or partner to step outside before asking. Then:
"I'd like to ask you something I ask all my patients, because it can sometimes be relevant to someone's health. Are you feeling safe at home? Is anyone causing you harm or making you feel afraid?"
If abuse is disclosed: validate their experience, assess immediate safety ('Are you and your children safe tonight?'), provide information about support services (National Domestic Violence Helpline: 0808 2000 247), and document carefully. Never pressure the patient to leave, that decision must be theirs.
An elderly patient is brought in by a carer who answers all the questions, explains every injury, and prevents a private conversation. Find a reason to speak with the patient alone: 'I just need to carry out a brief examination — I'll ask you to wait outside for a few minutes.'