“No one – not health professionals, teachers, social workers, neighbours, society and, least of all, politicians, can claim to have dealt as well as they could have with child abuse,” says Royal NZ College of General Practitioners Chairperson Dr Ralph Wiles. “But there’s nothing to be gained from an orgy of blame-avoidance and finger-pointing such has been set off today by the release of the Ministry of Health’s advice to the Minister on the issue.

“The briefing paper makes several erroneous claims and draws debatable conclusions from facts,” Dr Wiles says. “For instance, the claim that because GPs account for around one percent of reporting to CYFS, whereas the public and family members account for 45 percent, this indicates a reluctance on the part of GPs to report abuse. A caregiver who has abused a child will construct a plausible façade to explain the injuries to medical and other professionals and will often go from one doctor to another to get treatment. On the other hand, family members and neighbours are in a much better position to see how the child is treated in its own environment, and have much a much better opportunity to observe the family dynamic in a ‘normal’ situation over much longer periods. Naturally, someone in that position is going to detect more abuse.”

Dr Wiles reiterated that GPs did not “claim ACC for child abuse” as the Ministry report claims. “The only part of the ACC form which deals with cause is the part completed by the caregiver. The doctor is required to state the nature of the injury, and there is no more a category for ‘child abuse’ than there is for ‘sports injuries’. Having said that, obviously if a child arrives with signs of obvious abuse such as cigarette burns, any reasonable GP is going to take some appropriate action. The difficulty arises when you’re presented with cuts and bruises which might have arisen in the way the caregiver claims.” .. more

Claims that GPs were not following guidelines were also incorrect, Dr Wiles reiterated. “The document to which the Ministry refers are not guidelines on dealing with suspected child abuse. They are a set of instructions which general practitioners can follow in drawing up, within their own practices or across IPAs, guidelines of their own. That doesn’t facilitate a national standard, nor enable central collation of data – processes which the government has only recently opted to fund.

“In fact, the College has two sets of advice for GPs faced with suspected child abuse. One is in the material taught during a GP’s ‘basic training’ after graduating from medical school. The other is for vocationally registered GPs in the context of the overall WellChild strategy, and is dealt with in the College’s Quality Assurance material covering that programme.”

Dr Wiles says the College admits more needs to be done – which is why it is working with CYFS to develop a set of nationally acceptable and effective guidelines, as it did last year with the Ministry of Youth Affairs on the Detection and Management of Young People at Risk of Suicide.

“The College has experience in drafting guidelines and is willing to work with government agencies to tackle issues such as suicide and abuse,” Dr Wiles said. “But, as with suicide, there seems to need to be a sustained public focus on the topic before sufficient resources are committed to dealing with the problem.

“In the meantime, GPs have been doing their best. It is completely incorrect to say, as the Ministry has in this document, that GPs are ‘reluctant’ to report abuse because of confidentiality issues. No GP is going to ignore the plight of an obviously abused child in order to protect the abuser’s privacy. The difficulty arises when the issue is not clear-cut, and there’s a risk of initiating a terrible and distressing series of events on an innocent family – or alternatively of alerting authorities, thus losing contact with the child, and then watching helplessly as very little is done.

“Child abuse is a community problem requiring bipartisan political leadership, not finger-pointing and ducking for cover,” Dr Wiles said. “We’re not saying GPs can’t improve their performance, any more than any politician can honestly say they did all they can. We’re working on guidelines and taking part in the forthcoming ‘Stop the Hurt’ conference for that very reason. We would hope that the Minister would similarly set aside the political imperative to apportion blame and simply work with us, and other health professionals, to fix it – fast,” Dr Wiles said.

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Contact: Dr Ralph Wiles (07) 886-5239 or (021) 658-564 or:
Rex Widerstrom (04) 496-5962 or (025) 549-637

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