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Abstract
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In their interesting paper about the strong association between burnout among child abuse clinicians,1 the authors discuss whether burnout might have similarities with staff working within emergency departments and pediatric palliative care. This can be a relevant comparison regarding job demands and burnout and it seems also reasonable that increased risk of secondary stress and burnout can be mitigated by hope and meaning in work. Moreover, we also agree with the authors' conclusion that the concerned child abuse clinicians should be offered education in coping strategies in order to minimize burnout.1
But perhaps the child abuse clinicians have additional problems when compared to other medical specialties and situations. More specifically, do child abuse clinicians sometimes ask themselves if they are always doing the right thing? This question applies above all to a certain kind of presumed child abuse, namely the very young infants (peak age 2 months) where abusive head trauma is suspected but where no external signs of trauma are present.2 A systematic literature review disclosed that there is very low evidence of the diagnostic accuracy of the three findings, encephalopathy, subdural hemorrhage, and retinal hemorrhages ("the triad"), without external signs of trauma for predicting violent shaking.3 Nevertheless, in practice, child abuse clinicians in many countries continue using the triad, without external signs of trauma, to claim with a high degree of certainty that such an infant must have been shaken violently.4 Hence, we believe that a child abuse clinician might have a difficult time if he/she has given evidence as an expert indirectly or directly in a court of law and contributed to the conviction of a potentially innocent caregiver, to the removal of an infant from a caring family, and to the splitting of this family. Are such expert statements always in the infants' best interest?
If in doubt, we believe that child abuse clinicians sooner or later will suffer from a responsibility crisis. For example, in triad cases without external signs of trauma, child abuse clinicians might begin to doubt that all medical conditions have been ruled out when concluding that the infant must have been shaken. Are there medical conditions that are not yet accepted that can bring about the isolated triad spontaneously? Is the evidence behind the abusive head trauma theories as robust as...
Language: en |