Writing in response to recent high profile cases such as that of Sir Roy Meadow, which have highlighted "the crisis of confidence" developing between the General Medical Council (GMC) and paediatricians, David Foreman and Juliet Williams call for better guidance to prevent doctors from being deterred from raising concerns about child abuse and to restore confidence in child protection processes.
They point out that the number of complaints against paediatricians related to child abuse work increased by more than 500% between 1995 and 2003.
In addition, since 2003, registrations of children for emotional and sexual abuse have increased while those for physical and sexual abuse have declined. This, they say, suggests that doctors may be avoiding work related to abuse for which more detailed physical examinations are needed.
According to the authors, part of the problem is that there is a basic confusion in doctors' duties regarding child protection. Medical law still states that doctors have a duty of care to both the parent and the child, but current paediatric professional guidance incorrectly applies the Children Act principle that the welfare of the child must be placed over all other considerations. In fact, this only applies to the courts, when they make a decision governed by that Act.
Therefore, in child protection cases, doctors have conflicting duties both to the child and to the parents who may not feel that doctors are acting in their best interests, particularly if they are suspects and if retrospectively no abuse is detected. This situation worsens if the doctor is later required to act as an expert witness in court.
Recent hostile media campaigns have added to the pressure on doctors by making it less likely that the GMC will dismiss high profile cases because its duty is to protect the public and also the reputation of medicine while maintaining public confidence in the profession, say the authors.
So what can be done to reinstate confidence in child protection processes and prevent a reduction in child protection?
The authors call on the GMC and other professional bodies to issue more specific guidance for doctors on how to manage these conflicting duties of care in child protection cases.
They also suggest that complaints against professionals in child protection cases should be subject to independent scrutiny before they are referred to their professional bodies.
To avoid unwarranted public criticism the public also need to be better educated about child protection work, so that the dual role of doctors in these cases is better understood, they conclude.