Telling their stories: primary care practitioners' experience evaluating and reporting injuries caused by child abuse

To learn about primary care physicians' experiences in identifying and reporting injuries caused by physical abuse.

Two qualitative analysts facilitated a focus group of six Chicago area, primary care physicians. Physicians representing diverse practice settings were selected to participate in the discussion. The analysts reviewed and analyzed the audiotape transcription of the focus group for common emergent themes.

Two themes emerged: (1) the importance of the participants' own past experience identifying and reporting suspected child abuse and (2) the responsibility physicians experience as they strive to assess possible abuse within the time constraints of an office visit. Each physician described a sentinel event that continues to affect decision-making. The physicians described several obstacles to decision-making including a lack of knowledge about child abuse, their previous experience with child protective services (CPS), and the additional time required to evaluate and report suspected abuse. The discussion suggested that rapid availability of expert consultation improved participant comfort in decision-making when abuse or neglect is suspected.

Primary care physicians reported being strongly influenced by their previous experiences with suspected abuse. A better understanding of office-based experiences with suspected abuse is needed to guide the development of tools and systems to enhance the ability of the primary care physician to provide the best care for children who may have been abused.