Dealing with a possible situation of child abuse or child neglect presents physicians with many ethical dilemmas: How should the doctor properly screen the child for child abuse or child neglect? How does the doctor confront the parents when the doctor suspects signs of child abuse? Does the physician inform the parents of his or her obligation to report the suspected abuse to authorities?
Physicians often experience feelings of reservation and hesitation about continuing a professional relationship with parents while simultaneously suspecting child mistreatment. All 50 states have laws that mandate physicians to report cases where suspicions of child abuse exist. A “suspicion” is not an accusation but merely a request for further investigation. On one hand, failure to report could result in charges being filed against the doctor. One the other hand, doctors are reluctant to report because they know the family well or do not want to make the parents angry. Also, some doctors are unwilling to believe that child abuse or neglect is present even though an estimated 2,000 deaths per year are caused by abuse or neglect.
Although it is often difficult, physicians should inform parents of their obligation to report suspicions of abuse or neglect. The American Board of Pediatrics has published methods for doctors faced with these issues to help ease the tensions. In November 2009, the Board offered its first certification examination in the pediatric sub-specialty, child abuse pediatrics. In addition to being leaders in education about violence, child abuse physicians are skilled in diagnosis, intervention, interdisciplinary evaluation and case management. Child abuse physicians are not the only resource available. There are many other qualified physicians whose expertise and experience are comparable to board certified physicians. These specialists are able to answer questions, provide consultation and manage and follow cases through the demanding legal process. To read more about this topic see Physicians face ethical dilemmas when dealing with suspected cases of child abuse.