The Knowledge Level and Opinions of Physicians about the Medical and Legal Procedures Related to Physical Child Abuse

Abstract

Background: In order to diagnose child abuse, physicians need to consider the possibility of abuse in every child they encounter, have sufficient information about the topic and manage the cases according to current law. Aims: To determine the knowledge level of physicians on child abuse and to learn their opinions about the procedures when they suspect child abuse. Study Design: A questionnaire (cross-sectional) study. Methods: A detailed questionnaire was applied to 390 physicians of whom 233 were general practitioners. The first part of the questionnaire included demographic variables (age, gender, occupational experience) and the frequency of child physical abuse cases encountered, since that is the most easily diagnosed and proven form of abuse. The second part consisted of 32 questions about diagnosis of physical child abuse and procedures during the follow-up of the cases. Statistical analyses were performed using SPSS version 18.0. Results: Of the participating physicians, 47.4% (n=185) were female and only 13.1% of the physicians had some kind of postgraduate training on child abuse. The correct response rate of specialists compared to general practitioners was significantly higher. A total of 263 (72.3%) physicians thought that there was a specific law on physical child abuse in the Turkish Republic. More than two-thirds of physicians thought that reporting should only be addressed to Social Services and physicians should not be obliged to report to law enforcement. Conclusion: The results of the present study adds to the already known necessity for better training of physicians about physical child abuse and the need to refresh their knowledge through postgraduate courses. According to current regulations, it is obligatory to report abuse cases to the public prosecutor and/or police, therefore physicians also need training in respect of the legal status and medico-legal approach to these cases. ---------------------------------------------------------------------------------------------------------------------------------------------------------

Keywords

• Child abuse, physician, postgraduate, training, questionnaire

References

1. 1. Schilling EA, Aseltine RH Jr, Gore S. Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health 2007;7:30.
2. 2. Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord 2004;82:217-25.
3. 3. Markenson D, Tunik M, Cooper A, Olson L, Cook L, Matza-Haughton H, et al. A national assassment of knowledge, attitudes, and confidence of prehospital providers in the assassment and management of child maltreatment. Pediatrics 2007;119:103-8.
4. 4. Sofuoğlu Z, Oral R, Aydın F, Cankardeş S, Kandemirci B, Koç F, et al. Epidemiological study of negative childhood experiences in three provinces of Turkey. Turk Pediatri Ars 2014;49:47-56.
5. 5. Research Study on Child Abuse and Domestic Violence in Turkey. Republic of Turkey Prime Ministry Social Services and Child Protection Agency. 2010:36 (Cited 2015 December 7). Available from: www.unicef. org.tr/files/.../cocuk-istismari-raporu-eng.pdf
6. 6. Açık Y, Deveci SE, Oral R. Level of knowledge and attitude of primary care physicians in Eastern Anatolian cities in relation to child abuse and neglect. Prev Med 2004;39:791-7.
7. 7. Canbaz S, Turla A, Aker S, Peşken Y. Samsun merkez sağlık ocaklarında görev yapan pratisyen hekimlerin çocuk istismarı ve ihmali ionusunda bilgi ve tutumları. STED 2005;14:241-6.
8. 8. Offer-Shechter S, Tirosh E, Cohen A. Physical abuse-physicians knowledge and reporting attitude in Israel. Eur J Epidemiol 2000;16:53-8.

9. 9. Al-Moosa A, Al-Shaiji J, Al-Fadhli A, Al-Bayed K, Adib SM. Pediatricians konowledge, attitudes and experience regarding child maltreatment in Kuwait. Child Abuse Negl 2003;27:1161-78.
10. 10. Paavilainen E, Astedt-Kurki P, Paunonen-Ilmonen M, Laippala P. Caring for maltreated children: a challenge for health care education. J Adv Nurs 2002;37:551-7.
11. 11. Bannon MJ, Carter YH. Paediatricians and child protection: the need for effective education and training. Arch Dis Chil 2003;88:560-2.
12. 12. Borres MP, Hagg A. Child abuse study among Swedish physicians and medical students. Pediatrics International 2007;49:177-82.
13. 13. Theodore AD, Runyan DK. A survey of pediatricians’ attitudes and experiences with court in cases of child maltreatment. Child Abuse Negl 2006;30:1353-63.
14. 14. Van Haeringen AR, Dadds M, Armstrong KL. The child abuse lottery will the doctor suspect and report? Physician attitudes towards and reporting of suspected child abuse and neglect. Child Abuse Negl 1998;22:159-69.
15. 15. Levi BH, Brown G. Reasonable suspicion: A study of Pennsylvania pediatricians regarding child abuse. Pediatrics 2005;116:5-12.
16. 16. Reijnders UJL, Van Baasbank MC, Van Der Wal G. Diagnosis and interpretation of injuries: A study of Dutch general practitioners. J Clin Forensic Med 2005;12:291-5.
17. 17. Orhon FS, Ulukol B, Bingoler B, Gulnar SB. Attitudes of Turkish parents, pediatric residents, and medical students toward child disciplinary practices. Child Abuse Negl 2006;30:1081-92.
18. 18. Child abuse and neglect. Child abuse fact sheet, extent of the problem, 2002 (Cited 2015 December 7). Available from: http://www.who.int/ violence_injury_prevention/ childabusefacts/en
19. 19. Reijnders UJ, van Baasbank MC, van der Wal G. Diagnosis and interpretation of injuries: A study of Dutch general practitioners. J Clin Forensic Med 2005;12:291-5.