The child abuse lottery - Will the doctor suspect and report? Physician attitudes towards and reporting of suspected child abuse and neglect

Objective: To assess the responsiveness and attitudes of medical practitioners to the reporting of suspected child abuse or neglect. To determine whether characteristics of the medical practitioner (specialist or generalist, rural or urban based, age since graduation, gender, having children of their own) influenced the responsiveness to reporting. Method: A survey of all members of the Australian College of Pediatrics in Queensland (Australia) and pediatric registrars at a tertiary training hospital in Brisbane (n = 124) and a random sample of Queensland general practitioners (n = 100). The survey requested demographic details, responses to three case vignettes suggestive of possible physical abuse or neglect, and details of suspected child abuse or neglect reporting behavior. Results: There were a wide range of responses to the case vignettes, bur responses did not vary between specialties. Forty-three percent of all doctors had at some stage considered a case as suspected child abuse or neglect and decided nor to report despite a legal mandate to do so. General practitioners were more cautious towards reporting. The reasons for not reporting were multiple but highlighted perceived problems in the services available for the child and family once a report was made. Conclusions: There is need for continuing education of medical practitioners regarding symptoms and signs of physical abuse and the role of doctors in the multidisciplinary management of child abuse. To some extent children's outcome when presenting to medical practitioners as a result of child abuse or neglect is no better than a lottery, dependent on which doctor they happen to see. (C) 1998 Elsevier Science Ltd.