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    (Original post by ScheduleII)
    I have read that paed attachment is usually 6-10 weeks. I could easily get through that time without saying anything controversial about my beliefs on social services etc. and would not have to take part in any protection work. If I was concerned about something and decided it was in the child's best interest not to report, then who would know I was concerned? Not blabbing is enough to get through.
    The fact you would keep quiet about suspected child abuse and that's fine because "who would know?" is absolutely unforgivable and fundamentally incompatible with the personality a (good) doctor needs.
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    The fact no-one would know means that no-one could discipline me and I would be able to get on with my job of treating the patients. As mentioned several times, I do not want to go into paediatric medicine. I just want to get through my degree and if that requires a paediatric attachment I'll do one- thinking positively, I could save a family from the humiliating intrusion of the state by not passing on my nagging worries.

    It's a little like my maths classmate who also wants to do medicine, she doesn't like maths one bit but says it is a means to an end and will boost her application compared to a less "respectable" A-level.
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    (Original post by Beska)
    The fact you would keep quiet about suspected child abuse and that's fine because "who would know?" is absolutely unforgivable and fundamentally incompatible with the personality a (good) doctor needs.
    I'd rep you if I could!
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    (Original post by ScheduleII)
    The fact no-one would know means that no-one could discipline me and I would be able to get on with my job of treating the patients. As mentioned several times, I do not want to go into paediatric medicine. I just want to get through my degree and if that requires a paediatric attachment I'll do one- thinking positively, I could save a family from the humiliating intrusion of the state by not passing on my nagging worries.

    It's a little like my maths classmate who also wants to do medicine, she doesn't like maths one bit but says it is a means to an end and will boost her application compared to a less "respectable" A-level.
    except it's not like your maths classmate and that is a **** analogy and one you probably use to palliate your stupid bias ridden opinions
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    Palliate? That means to ease or reduce the suffering of, as in palliative care and the analgesic Palladone IR. What does it have to do with opinions, I wonder?

    The analogy is valid; she doesn't want to be a mathematician and I don't want to be a paediatrician (under the current regulatory system, and I can't bank on it changing although the new government are going in the right direction.)
    But we are both doing what we need to in order to get to our aim.
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    (Original post by ScheduleII)
    Palliate? That means to ease or reduce the suffering of, as in palliative care and the analgesic Palladone IR. What does it have to do with opinions, I wonder?

    The analogy is valid; she doesn't want to be a mathematician and I don't want to be a paediatrician (under the current regulatory system, and I can't bank on it changing although the new government are going in the right direction.)
    But we are both doing what we need to in order to get to our aim.
    Whether or not you want to work in childrens care doesn't mean a squat bit if difference. You will have to do mandatory child protection training (with updates), you will also deal with adults...who have children. Unless you go into biomed research and work with bacteria or..better yet get a job in a sex offenders prison to really open your eyes to reality.


    You're still a troll tho...
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    (Original post by ScheduleII)
    The fact no-one would know means that no-one could discipline me and I would be able to get on with my job of treating the patients. As mentioned several times, I do not want to go into paediatric medicine. I just want to get through my degree and if that requires a paediatric attachment I'll do one- thinking positively, I could save a family from the humiliating intrusion of the state by not passing on my nagging worries.

    It's a little like my maths classmate who also wants to do medicine, she doesn't like maths one bit but says it is a means to an end and will boost her application compared to a less "respectable" A-level.
    Remember baby P and Victoria Climbie? Remember how they got caught out for missing evidence or at least raising suspicions.

    At the end of the day the worst that can come from a mis-diagnosis of abuse is the parents having to go through the CPS system and possibly losing their child (as horrible as that is)

    The worst that could come from ignoring possible evidence of abuse is the death of the patient and possible criminal negligence on your part.

    You do seem oddly fascinated about this whole topic.
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    You might well have to do CP training. Whether you actually obey what you have been taught is a different matter. And working with adults- yes, there may become a cause for concern for their children, but this is a fringe issue. What could an adult do that made me suspect their children just might be suffering abuse or neglect? If they actually disclosed they were responsible for abuse I would have no hesitation in proceeding to protect the child/ren.

    I know all about Baby P and Climbie. The people who support integrated working (CAF/Contactpoint), strict safeguarding protocols and American-style mandatory reporting always cite them. I would counter with dozens of cases of children unfairly snatched from their homes.

    As far as the consequences of making or not making a report, that is a very difficult question. I have heard the point before that a child being wrongly removed is better than a child dying, but this doesn't convince me; if the child dies I have had no active part; the culpability is on the part of the parents. If I made a referral that set the S47 train in motion to a S31 and freeing order on the balance of probabilities only, that would be something I couldn't live with. So I would not report my suspicions.

    Although my academic interest in why people do evil is quite strong (and all philosophy for that matter) it is not enough for me to work as the HMP Whitemoor psychiatrist... unless I undergo a drastic metanoia.
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    I am not sure why this discussion is still going on. Others and I have quoted the GMC's 'Guidance to good medical practice; which say it is mandatory to report any suspicions of neglect. You said you wouldn't. Your opinion is therefore fundamentally unsuitable for the profession. Move on, consider a different course. End of thread.
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    Not everyone always follows the guidelines. As long as I can do it without being dismissed, I'll do it. It's not like having sex with a patient or writing addicts Diconal scripts, where you can get caught. If suspicions are in your head no-one will know unless you choose to tell them.
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    (Original post by ScheduleII)
    Not everyone always follows the guidelines. As long as I can do it without being dismissed, I'll do it. It's not like having sex with a patient or writing addicts Diconal scripts, where you can get caught. If suspicions are in your head no-one will know unless you choose to tell them.
    I rest my case.
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    (Original post by ScheduleII)
    You might well have to do CP training. Whether you actually obey what you have been taught is a different matter. And working with adults- yes, there may become a cause for concern for their children, but this is a fringe issue. What could an adult do that made me suspect their children just might be suffering abuse or neglect? If they actually disclosed they were responsible for abuse I would have no hesitation in proceeding to protect the child/ren.

    I know all about Baby P and Climbie. The people who support integrated working (CAF/Contactpoint), strict safeguarding protocols and American-style mandatory reporting always cite them. I would counter with dozens of cases of children unfairly snatched from their homes.

    As far as the consequences of making or not making a report, that is a very difficult question. I have heard the point before that a child being wrongly removed is better than a child dying, but this doesn't convince me; if the child dies I have had no active part; the culpability is on the part of the parents. If I made a referral that set the S47 train in motion to a S31 and freeing order on the balance of probabilities only, that would be something I couldn't live with. So I would not report my suspicions.

    Although my academic interest in why people do evil is quite strong (and all philosophy for that matter) it is not enough for me to work as the HMP Whitemoor psychiatrist... unless I undergo a drastic metanoia.
    The concept of a duty of care means that as a doctor, you may be still be culpable even if the fault is of omission, not a wrongful action. If you have a position of responsibility, it is not enough to wash your hands of a difficult case - it wouldn't be permitted of a policeman or social worker dealing with the case, and doctors are considered to have responsibilities of this kind too even if it isn't their primary duty.

    Children are harmed by members of their families - it is not an abuse of power for the state to act to protect them in those circumstances, it is what we expect a responsible state to do in a civilised society. In some cases, the decision may be found to be incorrect (with the benefit of hindsight). That does not make people who work in child protection "snitches", and to undermine that responsibility as a blanket policy is to put children at risk who might otherwise be protected.

    If you refuse to make difficult decisions to protect your own sense of righteousness, this is not the profession for you.
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    Omissions can sometimes be just as harmful as acts- the classic example being if someone is walking off a cliff and you don't try to stop them (which I have read much debate about.) There are situations where I would say that an omission is bad; say I was examining a pre-teenage girl during paediatric attachment and noticed an abnormal discharge. If tests showed she was infected with a disease that is always or nearly always sexually transmissible, or infected with HIV and she had no contact with blood, I would be reporting and to let the girl continue to be abused is wrong.

    My problem, which I have made explicit several times in the thread, is where there is only a suspicion or probability of abuse. Here, I would not report anything. I would class this omission as being less morally reprehensible than the act of making the child protection referral based on a hunch.

    And the removal of children from families where abuse or neglect is proved beyond reasonable doubt is quite within the duties of the State. I have nothing against this. I do, however, oppose the snatching of children from families who have done nothing wrong, which occurs far more often than it should.

    And I can make difficult decisions. The easy decision would be to make a report every time and let the named safeguarding liaison people, who would be more experienced, deal with it. It takes more moral courage not to cover your back and pass it on. I remember being 14 in school and hearing a conversation between two staff, one of whom was relatively new, while waiting at reception:
    New teacher: I'm worried about [name of pupil] after [incident]
    Pastoral officer: "Just jot your suspicions down, pass them to [name of CPC], then you'll be covered."

    It struck me as wrong even then, and my view has not changed.
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    (Original post by ScheduleII)
    My problem, which I have made explicit several times in the thread, is where there is only a suspicion or probability of abuse. Here, I would not report anything. I would class this omission as being less morally reprehensible than the act of making the child protection referral based on a hunch.

    ...

    And I can make difficult decisions. The easy decision would be to make a report every time and let the named safeguarding liaison people, who would be more experienced, deal with it. It takes more moral courage not to cover your back and pass it on
    This is why it is not the doctor's decision to make a distinction, and this is why the regulations are very clear. Any suspicion, no matter what, is reported. Then those who are trained to make the decisions on if a suspicion is justified do the job. The doctor makes no decision: if the doctor suspects it, report it. This is made very clear in neglect protection literature in my trust.

    Do you think a receptionist in the GP has the right to decide what illness is significant enough to require GP attention? No. If you're ill, you go through to see the GP. Same principle. You are trained to spot neglect, you are not trained to decide on ethical dilemmas regarding neglect. It isn't call covering your back: stop being so selfish. It is about protecting children that may be suffering abuse.
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    You are trained to spot potential neglect. In the same way, you are trained to spot potential abuse. The official guidance for practitioners uses the words "suspect" and "consider"; if suspect is used, then reporting is expected. If consider is used, then the doctor should apply professional discretion. However, you can get around this by saying you suspected something else which is not abuse and due to my propensity to treat all people as innocents until proven guilty, in accordance with immemorial legal tradition, I wouldn't be lying. Receptionists don't discriminate. They are not professionals; they are people paid hourly to do a job, and if someone has an appointment they must send them through.

    I don't trust the child protection officers in cases with any significant degree of doubt (for good reason); this is a view shared by many people, even when I was in school where some teachers supported my ideas on not reporting. A few openly admitted that they would not inform the designated child-protection officer if they thought a pupil was at risk, even though this would leave them exposed if something went wrong.
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    Suspicions do not automatically lead to a child being taken away.

    You refer it on to a child protection specialist (usually a paediatric clinician at the hospital) who will assess the injuries and monitor the situation if need be. Taking the child away is a last resort, and there needs to be solid evidence or a firm belief that it's in the child's best interests and that they are being abused.

    So say you notice some suspicious bruising. You ask the parents and they say "he tripped" but you're not convinced. You write in the notes that you think the child may be being abused. He comes in again with further bruising and you think "I'm sure something's going on here" so you refer them to the child protection specialist. They assess the situation and may contact social services if need be.

    These organisations don't split up families for the fun of it, they do it out of necessity. If you aren't willing to recognise and accept this then medicine is not the career for you.
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    I know that suspicions do not automatically lead to an FCO [S31]. However, the idea that taking the child away is a last resort is laughable now; nearly every order applied for by the LA is rubber-stamped in court. High Court Fam Div are only slightly better, and appealing to them takes a while and can be expensive. A 55 per cent chance of abuse can be enough to rob the child (what mathematics do these people use? Stats do not apply to individual cases, and *** hoc ergo propter hoc is pure fallacy, to say nothing of the non sequiturs in "evidence" presented to the judge.) There does not need to be evidence, at least in the usual English meaning of that word. The hearsay of experts is treated as unimpeachable. I would write nothing in notes unless there was no conceivable explanation of how the injuries could be accidental.

    Some people, while not outright lying, will subtly alter the meanings of words to get people to do what they want to.
    For example, many organisations who work with children and young people use the word "confidential". That, to most people, would mean it is only shared within the organisation and on a need to know basis, barring special conditions such as terrorism or risk to others. Not any more! They often share data with everyone else who works with that child or family, justifying it as protection. EU law forbids such nonsense but our government do not seem to care much. Numerous stories are coming through online from the family courts; the only reason that people don't hear more of it is that the system is under privacy and mainstream media are forbidden by law from disclosing details.

    I have written before in the thread that if the injuries or illness does not tally up with the explanation provided, I would do something about it. But too many people are making referrals on every little thing just to make sure. Even social workers have came up in Community Care bemoaning the vast volume of CPR's from hospitals and GPs as "poor quality" ie little cause for concern and a waste of social services' time to investigate. My position is not "never make a referral, even if a little boy has multiple fractures and his parents have no idea why." It is, "trust the parents until there is very good reason not to." If that turns out to be too late and the child dies, then it is tragic but not my fault.
 
 
 
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