Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
First Principles
- Gert Martin Kaiser (26 March 2004)
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Conflicts of Anonymity
- J Seager (23 April 2004)
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Re: Conflicts of Anonymity
- Mark Struthers (24 April 2004)
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Gert Martin Kaiser, GP-principal 16 West Street Newport Isle of Wight PO30 4EU
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Dear Editor The articles you carry in this weeks journal do show that as a profession we are still able to critically review our own firmly hold beliefs in the light of evidence. Do no Harm. The events described ring true from my own experience, having to help parents to pick up the pieces of their destroyed life after an "investigation". Often these families are from a poor socio-oeconomic background, they are questioned seperatly, without representation and put under immense pressure. Parents have been told that the only chance they have to get their child or children back, is by acting as a witness against the other parent! If at the end of the day there is no case to answer, parents are left under an ongoing threat of "we are going to keep a close eye". Bricks through the window from neighbours who don't want "child abusers" in their neighbourhood is another outcome. Not surprisingly parents become depressed, often requiring therapy for years afterwards. There seems to be no research looking at longterm health -outcomes for both children and parents that have been through such a process and found innocent. When child-proctection teams are challenged over this approach their standard answer is "the interests of the child are paramount". Unfortunately this aggresive approach does not confine itself to cases where actual harm has happened and a cause justifiably has to be found. Child protection services in my area have for years demanded access to parental health information without consent, particullary mental health information under the pretext that parents with mental health problems are likely to harm their children. Parents who are admitted to a mental health -unit have their "parenting skills" assessed under the lead of social services. They are to be informed that such a process takes place but have no representation or choice. Having been to "educational meetings" with "child-protection experts" from other areas, my impression is, that this is a common approach and misconception. Health-workers who deal with child-protection should have screen savers saying "First Do no Harm". They might also sometimes benefit from some further training in psychological medicine. Yours sincerely GM Kaiser Competing interests: None declared |
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J Seager, Consultant Paediatrician Wirral Hospital NHS Trust CH49 5PE
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Sir, Is it really fair of your anonymous correspondent (Parents As Well As Children Need Protection, Personal View BMJ 2004: 328: 775) to give details of a case of suspected child abuse without being asked to declare any possible conflict of interest? The author tells us only that he knows the family well. The events which he describes will be instantly recognisable by the team caring for the child at the time (and perhaps still). It will increase the pressures under which they work to be subjected to implied criticism in this questioning issue of the BMJ. Paediatricians will be happy with your colourful warning on the front cover not to diagnose child abuse on the basis of a single obscure physical sign. It is more difficult to accept that the BMJ by failing to ask anonymous contributors where they are coming from may be confusing an important debate. J. Seager, Paediatrician Competing interests: None declared |
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Mark Struthers, GP Bedfordshire
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In my view, the anonymous correspondent presented a fair account of the imbalance of power that currently exists in child protection. The retired grandfather makes a forceful and cogent appeal to natural justice in this field. By contrast, there was a certain malefic quality to the strange offering by senior paediatrician Dr John Seager. It is difficult to accept that the BMJ should post such vague and insubstantial wisdom, though readers will not be confused by where Dr Seager is coming from. While the team of paediatricians are preoccupied with the rigors of implied criticism, it is reassuring to know that there is little pressure from the guilty conscience on their continued labours. Competing interests: None declared |
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