Rising child abuse complaints and paediatrics
Authors: Nadeeja Koralage
Publication date: 17 Apr 2004
With the rising number of unsubstantiated complaints against paediatricians over child abuse cases, it's no wonder that many designated child protection posts remain unfilled, as Nadeeja Koralage finds out
Well publicised child abuse cases and complaints against doctors have made specialists such as Professor Roy Meadows and Dr Paul Davis household names. Both tabloids and broadsheets now claim that Munchausen syndrome by proxy is a “controversial scientific theory... responsible for serious miscarriages of justice.”1
Websites have been set up to discredit child abuse allegations,2 and an anonymous paediatrician has spoken out about how he “had been threatened with a shotgun” after investigating a child abuse allegation.3
According to the Royal College of Paediatrics and Child Health (RCPCH), a third of all designated child protection positions (every NHS trust should have one) remain unfilled. Who would want a career in this specialty in such a hostile climate?
The RCPCH complaints survey
Earlier this year, the RCPCH completed part one of a two phase survey into complaints made against paediatricians.4 Researchers asked paediatricians who had been concerned with child protection to detail any complaints that had been made against them. The survey showed that last year over 100 complaints against paediatricians were made; this is more than a five fold increase on the total made in 1993 (see box for key results).
Part two of the research will aim to detail further and analyse the complaints brought against the 62% of doctors who were willing to participate in a telephone interview about their experiences.
Neil McIntosh, vice president for research at the college and author of the research, states: “These complaints are largely reflex accusations by the person accused of damaging their child. As a result, doctors spending a fair amount of time in child protection are feeling undervalued and unprotected themselves.”
He is also alarmed at what he calls the “savaging by the media”: “In a large proportion of cases, the media and family are prepared to go public before a judgment is given, and paediatricians in these instances have no way of defending themselves against the charges made.” He continues: “There are issues that are coming up constantly, which lead to this rebound complaining, and this needs to be brought out and addressed. If you've not battered your baby, you are certainly angry to be accused. If you have battered your baby, you are both scared and angry that you've been found out.”
Calls from solicitors
Dr Harvey Marcovitch, press relations officer at the RCPCH says: “The college gets a lot of phone calls from solicitors who represent parents and need a specialist to look at their child's records. It's very difficult to find people who are willing to do this.” He believes that this is because of the increase in complaints against doctors and the resulting publicity: “You can't respond to any media attacks yourself because of confidentiality.”
Reasons for rise in complaints
The president of the RCPCH, Alan Craft, thinks that there are many reasons why complaints have increased: “Firstly, there is now a general complaining culture in society. Secondly, it's a natural reaction for parents who have been accused of harming their children to find some way of hitting back. Thirdly, there has been an orchestrated campaign against certain specialists, by a small group of parents, mostly using the internet.” He adds: “We need the public to understand that if paediatricians are reluctant to report child abuse cases, then children will be unprotected.”
Who will protect the unprotected?
Mary Marsh, director of the National Society for the Prevention of Cruelty to Children (NSPCC), agrees: “It would be a tragedy for children if a rise in unjustified complaints deterred paediatricians from working in child protection, making diagnoses of child abuse, or providing a professional opinion when called to do so.”
Raising the threshold?
Dr X, who had a complaint made about him, told BMJ Careers about his experiences: “I made a referral to social services about a child who I felt was at considerable risk. I still feel that this is the case. But I subsequently found out that complaints had been made about me to the trust.”
It took many months for the complaint to be dismissed, but Dr X is still concerned about repercussions. “I want to remain anonymous because I don't want that family after me again. You see other doctors who miss child abuse cases, and yet no action is brought against them, even if the child ends up dead. If I want to continue in paediatrics, it seems that I may have to raise my threshold about what is acceptable—and that's very sad and cynical.”
GMC spokesperson Jo Tupper says: “High profile cases, such as the Shipman case, have brought the GMC to the public's attention. Changes in society mean that people are more willing to complain. I can personally see why doctors may be put off child protection work, but an increase in complaints against paediatricians is something for the royal college to deal with. We have to act on the complaints we receive.”
Results of the RCPCH child protection survey4
The overall response rate was 78.7% (4776 replies)
Of the 3879 practising or recently retired paediatricians, 13.8% (536) had been subject to complaints related to child protection
786 individual complaints were made
86 of the individual complaints were referred to the General Medical Council (GMC). Excluding ongoing complaints, none was upheld
84% of complaints received no publicity. However, in nearly a quarter of cases where the complaint was unproved, the doctor still received negative publicity
50% of complaints were made about a doctor who was a member of a child protection team or a designated doctor
29% of doctors were less willing to become involved with potential child protection cases following their complaint
Keeping up with best practice
Enid Hendry, head of child protection and consultancy for the NSPCC, says: “Doctors need to practise discussing child protection issues, so that the first time they have these conversations, there are no `at risk children' involved. Paediatricians cannot opt out of child protection work, nor look away. But they need access to up to date, evidence based information.”
This evidence base is changing and paediatricians should know about it. For example, perimacular retinal folds, one of the criteria used to diagnose shaken baby syndrome, was recently questioned in the BMJ when the authors concluded that “this diagnosis was not supported by objective scientific evidence.”5
As there is currently no consistent package of child protection in the United Kingdom the NSPCC is working with the RCPCH to develop child protection for paediatric house officers and registrars. Enid Hendry explains: “The training we are developing will mean that paediatric senior house officers will receive one day and specialist registrars will receive two days of face to face teaching.” The teaching will supported by a CD rom containing learning resources for self directed learning as well as preparatory reading. It will available at the end of 2005.
Go to web extra at bmjcareers.com/careerfocus for the references
Nadeeja Koralage intercalating student
University of Westminster