Family doctors usually ignore requests to attend case conferences to discuss the possible sexual abuse of children who are their patients, newly-published research findings suggest. The study, by Dr Helen Buckley of Trinity College Dublin, found that in one community care area in the Eastern Health Board region, GPs attended only 20 per cent of the case conferences to which they were invited over six months.
Dr Buckley is co-ordinator of the advanced diploma in child protection and welfare in the department of social studies in TCD. A report on her research is published in the Irish Journal of Social Work Research.
She found that family doctors are reluctant to tell health boards about suspected child abuse and don't want to get involved with social workers, gardai or others engaged in the system.
Commenting on her report, Dr Cormac Macnamara said it was rare for a family or a child to disclose sexual abuse to a GP. In 30 years of practising with 10 doctors, he had never known it to happen. Dr Macnamara is president of the European Union of General Practitioners and a past president of the Irish Medical Organisation.
He believed families feared that telling a doctor would set in train a series of events involving health board officials and other people. Generally, people went to GPs about sexual abuse only after it had become known to the health board or the Gardai and it was generally the perpetrator who went to the doctor. After abuse was disclosed, "life becomes unbearable for them in the family or the community and they come to the GP for medical assistance", sometimes with suicidal tendencies, he said.
He had known it to happen only once in 30 years that a perpetrator went to a doctor before he was caught.
For these reasons, he said, family doctors should not be seen as the key professionals in dealing with child sexual abuse.
In relation to physical abuse, he said one-off, traumatic assaults were usually seen by accident and emergency departments in hospitals. GPs were most likely to pick up on physical abuse where a child brought for treatment appeared neglected or undernourished. In such cases the doctor would look for cigarette burns or other signs of abuse.
Dr Buckley's research was based on a study of 72 child-abuse referrals to social workers during one six-month period. She conducted in-depth interviews with five GPs involved with the cases. Dr Buckley says she cannot claim that the small number of GPs interviewed are representative of their profession, but she adds that her findings are similar to those arrived at in Britain in research involving much larger numbers of doctors.
She found that none of the five doctors interviewed had a copy of the Department of Health's child abuse guidelines and that two of them "were completely unaware of their existence".
Only four of the 72 child-abuse referrals were made by GPs, and in these four cases they were only passing on concerns voiced by the children's parents.
One doctor contacted by a health board regarding a case of child abuse "had never realised or even suspected that the children in the particular case, whom he had been treating for virtually all of their lives, had been subjected to gross sexual abuse by their father".
One GP told her he had "handled" a previous child sexual abuse case "on his own" because the family "did not want to take it further, they did not want to involve the Eastern Health Board, community workers, police, etc." In another case, "though he had been approached by the parents at an earlier stage with information that their daughter had been sexually abused, he had not considered reporting it" because he would regard that as a breach of confidentiality.
GPs told her they found it difficult to fit case conferences called by health boards into their schedules and they regarded them as a waste of time.