IntroductionAccording to (TUSLA- The Child and Family Agency 2015) child abuse can beranked under four main categories that include: emotional, neglect, physical, andsexual abuse. I came to recognize the importance of making a decision regardinga potential child abuse case especially two weeks ago after meeting with myearly patient contact program (EPCP) patient. Two of my friends and I wereassigned a lovely 5-year-old boy who is diagnosed with down syndrome and hemophilia.I had the pleasure of meeting him with both of his mother and aunt who aretaking care and cherishing him beyond description. Because of the boy’s healthconditions, he is prone to bruise and bleed easily even with the slightesttouch. The mother whimpered the loathing looks and anger she’d get every timeshe goes out to a public place because people simply assumed that the kid wasabused because of all the bruises, and how physicians ask unusual questionsevery time she rushes her son to the emergency department thinking that shemight have used the boy’s condition and abused him.
As a future physician, I believe it is rather important to acquire theskill needed to evaluate the case and to know when to report a case of an abuseand when not because the slightest misjudgment can put the parents/caregiver indire straits or the opposite if a case of abuse went unnoticed putting thechild in a perpetual abuse exposure that can have a long-term effect on theirphysical and mental health. The legaland ethical frameworkPhysicians havea legal obligation to report upon rational grounds when suspect abuse and/orneglect and they are required by legislation to contact the HSE Children andFamily Services without delay to directly disclose all information pertainingto the child safety concern. Duty to report overrides patient confidentiality;physician is protected against liability; however, the parents or guardiansshould be informed of the GP’s intention to report unless informing theparents/guardians might jeopardise the child’s safety. In cases in whichuncertainty exists, GPs may be required to discuss their concerns with otherprofessional personals who have a better experience in the field. Thus, GPsmust be aware of how to reach out to contact relevant people for expert medicaladvice (Department of children and youth affairs 2017). The standard reporting procedure asspecified in the (Department of children and youth affairs 2017) is as follows:- Reporting child abuse or neglectshould be done without any delays to the HSE children and family services inperson, by telephone or in writing.
– Before making an official report,it is advised to discuss all concerns with a specialized professional, ordirectly with the HSE children and family services. – By no means a child should be leftin a situation that exposes them to harm or risk awaiting HSE intervention. – The standard report form should beused when reporting child welfare and safety concerns to the HSE however, theHSE follows up on all referrals, even if the standard report has not been used.Challengesposed on doctors when reporting Probably one of the biggestchallenges that physicians encounter when faced with a child abuse case is thelack of professional training to deal with abuse victims because their presentingsigns and symptoms can be confused with other potential differential diagnosesas in the case of my EPCP patient. A study performed by (Bannwart and Brino2011) in Brazil tried to identify the difficulties in reporting cases of abuseagainst children and adolescents from the viewpoint of pediatricians in whichit showed that 75% of participants had doubts about whether to report or notand there was a frequent belief that health care professionals must confirm,and check based on solid evidence if the abuse indeed occurred fearing frommaking a false accusation. Many also reported that they lack the guidelinesthat should be followed in case of child abuse reporting and that socialservices do not exist 24 hours at the hospital.
The study also showed that someof the participants expressed their concern of being legally involved and thehassle of having to deal the juvenile court and that it would impact theirrelationship with their patients especially in small communities where peopletend to know each other well. Therefore, it is vital to educate health careprofessionals about the conceptual distinction between reporting anddenunciation for the sake of preventing the avoidance behavior of health care professionalsas for the most applicable reporting procedure in cases of alleged orestablished child abuse.PotentialsolutionsAs a future physician, I will probably be faced with cases of childabuse. I believe it is rather important to be exposed and prepared to deal withthese scenarios from early on. Primary precautionary measures have to bedeveloped parallely to health care measures to reduce the incidence of child abuse.
The training of health professionals should aim to invest in promotingbehaviours to shed the light on the rights and needs of both children andadolescents to increase the capacity of professionals to recognize cases ofabuse and expanding their duty to report abuse, consolidating the linkagebetween these reaction at all levels, institutions, and agencies that areresponsible for fulfilling the entitlements of children and adolescents.