Medical Child Abuse

Grubenhoff, Joe Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
Sun Nov 13 14:50:51 UTC 2016


Mark, 
Thanks for sharing. Full disclosure: I have not yet read the attachment but "medical child abuse" is replacing Munchausen's syndrome by proxy and is just a new name for an old problem. As a pediatric ED doc at a tertiary care medical center, I can tell you that there are parents who will fabricate, exaggerate or actually induce symptoms in their children in order to get invasive tests done. What the psychosocial underpinnings of this behavior are remains unclear. 

There is a trend in legal and even some medical circles to dispel the validity of child abuse as a dx (in particular Abusive Head Trauma AHT formerly known as Shaken Baby Syndrome). They are trying to undo half a century of work started by C Henry Kemp that has undoubtedly saved numerous lives. 

Child maltreatment, especially AHT is itself a Dx at high risk of Dx Error due to several factors: 1) vague sx that mimic other diseases or normal infant behavior because large amounts of blood can accumulate in the head when the fontanelle and sutures are open 2) failure to consider (base rate neglect, availability) 3) thinking that only certain types of people are abusers (visceral bias) and we could go one. 

I bring this up because I have more stories than I can count where Dx Error has dismissed key findings, a child was not protected early and the abuse continued and the child was killed or permanently and profoundly disabled. Child abuse is not a single traumatic event but a progressive disease that benefits from screening (aka child abuse reporting laws).

I see child abuse on a REGULAR basis in my job. I hope no one else has to. But as a community of providers very interested in how Dx Error contributes to patient harm, I hope that we are very conscientious in considering how the cognitive psychology of diagnosis and a disease that is trying not to be diagnosed due to the legal implications for the perpetrators make child abuse so hard to identify. 

Joe Grubenhoff MD,MSCS
Associate Professor of Pediatrics 
University of Colorado SOM
Attending Physician 
Children's Hospital Colorado 

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> On Nov 12, 2016, at 23:20, "graber.mark at GMAIL.COM" <graber.mark at GMAIL.COM> wrote:
> 
> This is hopefully not a diagnosis you'll encounter, but the relatively new diagnosis of "medical child abuse" is taking hold in certain areas of the country.  Parents so charged can lose custody of their children and be subject to criminal proceedings.  
> 
> The enclosed review by Maxine Eichner studies this issue from a diagnostic error perspective, and concludes that this diagnosis has no firm criteria, and may often be incorrect.  Her scholarly article will hopefully shed some light into this dark and messy area. The review was just published online by the UC Davis Law Review {50 UC Davis L. Rev. 205 (2016)}
> 
> Mark
> 
> Mark L Graber, MD FACP
> President SIDM
> 
> 
> 
> 
> 
> 
> 
> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
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> To unsubscribe from the IMPROVEDX list, click the following link:<br>
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> </p>
> <Eichner - 2016 - Bad Medicine - Parents, the State, and the Charge of Medical Child Abuse.pdf>
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