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You are a GP Registrar working in a clinic in Tooting and are just starting your morning surgery.

Your first patient is a 14 year old girl called Lilly. As you are waiting for her to come in you look through her notes and see that the last time you saw her was 5 years ago when she had appendicitis. She comes into the room accompanied by her mother. You notice from Lilly's school uniform that she attends a nearby Private Girls School.

'So, what can I help you with?' you ask. Lilly's mother looks at Lilly and says 'Well, show the doctor then.' Lilly pushes up the sleeves of her school uniform jumper to show you multiple linear scars and scratches on her forearms. 'I walked into the bathroom while Lilly was in the bath yesterday and saw them' says her mother, 'She won't tell me how they happened.'