The Issue and my ethical position
The main issue in the case is suspected child abuse and neglect and whether a physician should initiate diagnosis, taking into consideration the strong relationship between the physician and the family. My ethical position is that Dr. Peterson should begin an evaluation and diagnosis process owing to the increased number of injuries her patient Adrian has been presenting over the last one year.
How the Scenario might play out or Impact me in my Role as a Nurse Practitioner
As of 2011, more than 3 million children in the US were affected by child abuse, a clear indicator of how a major epidemic child abuse is in the US (Caneira & Myrick, 2015). As a nursing practitioner, I fully understand that I have a vital role to play as far as prevention, diagnosis, and treatment of child abuse and neglect is concerned. To provide the right care in case of child abuse, a nurse practitioner has to have a clear understanding of the clinical manifestation, differential diagnoses, as well as epidemiology to accurately identify child abuse and rule-out other conditions. Such an agreement also goes a great length in the development of an appropriate plan of care. Prompt and accurate diagnosis of child abuse makes it possible to provide the necessary attention to an abused child even at the acute phase, and might also help reduce the effects experienced later in life ( Caneira & Myrick, 2015). Such a scenario would call into play my insight and knowledge about clinical and legal aspects of child abuse. The more knowledgeable any nursing practitioner is about the legal and clinical issues of child abuse, the higher their ability to address the challenges that present themselves in such cases (Lazoritz, 2010).
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Legal, Ethical, and Professional Evidence Supporting my Position
Available evidence shows that the prevalence of child abuse and neglect within the US is quite high. In most of the reported cases, the abuse occurs generationally. Despite its high incidence, child abuse remains mostly underreported. As such, vigilance on the part of family physicians is of great significance. The General Medical Council acknowledges the critical role that Doctors play in addressing child abuse. In one of its recent guidelines, the General Medical Council reports that doctors have a duty to air concerns that a child might be at risk of child abuse (Dyer, 2012).
The importance of further investigating suspected cases of child abuse is also exemplified by the fact that children who are victims of child abuse or neglect are at a higher risk for developing long-term physical, emotional as well as medical problems that can be traced back to the traumatic experiences of abuse and neglect. Caneira and Myrick (2015) point out that the effect of child abuse is of great significance to the practitioners that care for children as well as the survivors that might be in need of care in later stages of their lives. The investigation, referral, and treatment of acute cases also come at a very high cost, with reports indicating that the amount it costs Medicaid to deal with such cases every other year is $5.9 billion. The costs of lifelong treatment are also quite high, with Caneira and Myrick (2015) reporting that the projected national cost, as well as future productivity loss as a result of neglected and abused children, ranges between $658 million and $1.3 billion. For every other case of child abuse, estimates show that it will cost every victim $210,000. As such, addressing child abuse at an early stage will go a great length in reducing the lifetime economic burden to the victims as well as the nation as a whole.
It is also important for Dr. Peterson to initiate evaluation since all states in the US call for healthcare providers and a range of licensed professionals to report cases of suspected child abuse and neglect to the right authorities. The state laws have provisions that protect healthcare providers that make such reports from liability. On the other hand, failure to report child abuse might come with far-fetching consequences. In most of the states, doctors and other healthcare practitioners can be charged with a misdemeanor if they turn a blind eye to cases of child abuse. Brown (2012) points out that if a child suffers harm due to a physician's failure to diagnose signs of possible abuse, or when a minor's injuries do not receive the right evaluation, referral or treatment, then the physician involved can be a subject of medical malpractice. By initiating diagnosis and evaluation, Dr. Peterson will be able to avoid such an implication.
Doctors can also be held legally responsible if they accurately diagnose possible child abuse but fail to report the issue promptly, and the affected child ends up suffering more harm as a result (Brown, 2012). Sharing concerns about probable child abuse with other clinicians involved in the child’s medical care and follow-up does not amount to a HIPAA violation ( Brown, 2012). This implies that doctors can arrive at a better decision to whether initiate an investigation or not by consulting with other practitioners involved in a child’s care.
Strategies and Solutions for Addressing the Issue
There is no doubt that child abuse and neglect has been on the rise in the US. Addressing the problem is within the scope and responsibility of health services. One strategy that can be used to address child abuse and neglect is enhancing economic supports to families. Approaches that can be used under this strategy include establishing family-friendly work policies and ensuring that household financial security is strengthened. Another strategy would be the provision of quality education and care in early life. Additionally, it will be important to consider enhancing parenting skills in a bid to promote healthy child development.
Other Ethical Issues the case brings to Light
One outstanding ethical issue that the case brings to light is privacy and confidentiality concerning patient information. Is it right for doctors to share their patient's private information with other clinicians or authorities especially when the patients are minors?
References
Brown, J. L (2012). Physicians have ethical, legal obligation to report child abuse . Retrieved from http://www.aappublications.org/content/33/3/20.1
Caneira, L., & Myrick, K. M. (2015). Diagnosing child abuse: the role of the nurse practitioner. The Journal for Nurse Practitioners , 11 (6), 640-646.
Dyer, C. (2012). Every doctor has a duty to report suspected child abuse or neglect, says GMC. BMJ , 345, e4719
Lazoritz, S., Rossiter, K., & Whiteaker, D. (2010). What every nurse needs to know about the clinical aspects of child abuse. American Nurse Today , 5 (7).
