Tuesday, May 12, 2009

Perspective: Child Abuse Detection

Perri Klass writes in today's New York Times about her experience with child abuse detection and the evolution of expertise in the pediatric profession...

The conclusion is especially important:
The child abuse experts don’t want the rest of us in the profession to stop thinking about the subject. “I think the average pediatrician can diagnose this, even though it’s becoming a specialty,” Dr. Legano said.

But it’s an emotionally difficult diagnosis for a pediatrician to contemplate, especially when it concerns a family you feel you know well. And all too often, it is a diagnosis we fail to consider in families that don’t match our mental profiles of abusers. That’s why pediatricians and parents alike need all the clinical experience and all the science we can get, deployed on the side of the children.

While "average" may be statistically accurate, this excellent article by Dr. Cindy Christian describes the minimal levels of training that medical students receive, and the resulting perception among a significant number of practicing physicians that they lack skills needed to evaluate cases.
Resource: Professional Education in Child Abuse and Neglect, Cindy W. Christian, http://www.pediatrics.org/cgi/content/full/122/Supplement_1/S13
Abstract: Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe. Pediatrics 2008;122:S13–S17

Two thoughts. First, "child abuse detection", not prevention, seems an apt term to describe this important process. Second, I wonder how medical students and practicing physicians would describe their training and skills in prevention education? There's one skill set required to know how to diagnose the consequences: the skill set to do something about preventing the consequences is likely to be much different...

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