Expert: GPs need support

Family doctors need more help to deal with suspected child abuse cases, says Starship paediatrician Dr Patrick Kelly.

Dr Kelly - who has advised the Government that all professional groups should work as a team to tackle the problem - said GPs probably saw at least as many cases as social workers but they had virtually no experience to prepare them for the awkward questions involved.

"You've got this poor GP who's had two hours' training in his fifth year. He's sitting in his practice at 10 o'clock on a Friday night and this child comes in with bronchiolitis [inflamed lungs].

"He listens to the chest and notices the child's got two or three bruises on their chest, which is an unusual place. What's he going to do?"

Dr Kelly said if the parents looked all right, the GP probably wouldn't even mention it.

The alternative was to notify the case to Child, Youth and Family, which often seemed too big a step for an unconfirmed suspicion.

In Auckland, the GP could refer the case to Starship hospital for an x-ray and, if necessary, a referral to the multi-disciplinary child abuse team. But the process could take hours.

Dr Kelly said hospitals had to stop being the reluctant partner and accept responsibility for child abuse.

"District health boards need to recognise that children under investigation by CYF are as much a part of the health service they have to deliver as the children referred in by a GP for a paediatric clinic."

Paediatrician Dr Teuila Percival of Kidz First at Middlemore Hospital said many doctors needed a change of attitude, as well as better training.

"There's a reluctance to make a diagnosis or even entertain the possibility because then you have to think about doing something."

ABUSE HEARTBREAK FOR DOCTOR

Watching the effects of abuse on young children is heart-breaking, says an experienced family doctor and domestic violence educator.

Otara-based Dr Faye Clark vividly remembers seeing one mother, referred for a check-up on her two pre-school children.

The children were taken into CYF care and the mother went to a refuge, but she was saddened by the mother's older son, aged about 12, who was clearly acting as the real parent in the family.

"I'll never forget his little face because he just looked exhausted."

Dr Clark said spotting child abuse was challenging for GPs because families were on their best behaviour while with the doctor.