Behavioral ethics question

[WilliamsEph]

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Q: A mother brought her 7 year old son in to see the doctor for sexually abusing his 5 year old sister; he did this after accidentally seeing their parents having sex.

What should the doctor's response be?

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I would think report to child services, but would the doctor also report to the police?

Also, in cases where you as a physician see evidence of a parent sexually abusing a child do you report to both child services and the police?

thanks

 

[Avoidthetiger]

Why would you call child services so quickly? The parents have potentially done nothing wrong.

I think the first step would be to get the child alone and verify that he has not been sexually abused himself -- either by the parent or another adult. Acting out sexually at this age could be a sign of abuse -- but often it is children just mimicking what they see in real life and/or TV. Children are also very interested and curious in male/female genitals and differences (though usually younger than 7.. i think it peaks around age 4, and then kids become more modest).

If the child hasn't been abused, I would have both the doctor and parent explain why this is inappropriate behavior. if it continued, I would advise a therapist.. If I felt like his home was not a safe place, I would then contact child services. A cop might be good also at that age to "scare" the kid if this behavior continues.

 

[Jonari]

Would you mind sharing where you got this question from? I really need to do as many of these questions as possible, since I get a lot of these wrong....thanks!

 

[medpack87]

i dont see anything on the question stem that would make me call on child protective services for child abuse. Are there answer choices for the question??

This question seems too vague (as most of the ethics questions), and usually having some options from where to select, helps to choose the "most appropriate one". So if in the answer choices, calling child protective services stands out as the most logical answer, then I would do it. Just report them though, you don't need to call child services AND the police.

 

[loveoforganic2]

Maybe it wouldn't be the right answer on the test, but I wouldn't be terribly suspicious of abuse here. The story's plausible, the behavior isn't grossly abnormal for the age (depending on what the actual abuse was), and it's not like the child had physical abuse that need to be taken care of by bringing the child in - the whole reason for the visit was concern over the behavior

 

[WilliamsEph]

Yeah it was vague. Sorry, don't have the answer choices. Saw this discussed on another board and had noted it down and finally got around to looking up the answer.

BTW, I bought a book that is relatively recent called "Khan's cases: Medical Ethics 101" that discusses about 100 ethics cases. Thought it was really good. I also did Conrad Fischer's 100 cases and that it was good. I think I'm covered with these 2 books.

 

[beatsbydre]

Going from common sense, what I would do here is to not focus on the child but rather focus on the parents. If there is any evidence of child abuse (so if the parents forced their kids to watch them have sex), a call to the child services would be necessary. If the kids accidentally saw their parents having sex, can you really punish the parents? I think not and child services would not do much, and the same argument goes with police. Remember child services will take away the kid into a foster home -- this is definitely worse than living with 2 parents who have sex and forgot to lock the door. And obviously, if the parent sexually abuses the child, that's an easy call to child abuse services. A call to the police would not be necessary since child abuse services will get police involvement if they feel it's necessary -- but it's their call, not yours. And obviously, if you really want to call the cops, go for it....

The best way would be some sort of behavioral therapy. Simply saying to the child you should not do this would not do much since there will be a LOT of follow-up questions from the 7 year old kid regarding why not (and I saw mommy and daddy doing it...). Too much knowledge at that age is detrimental to the kid's psychological growth + logic reasoning starts at a later age. For this case, I would leave it to the professionals (child psychologists). But then again, referring is a pretty bad answer choice in general on the USMLE, so for the purposes of the exam, perhaps you should tell the kid to not do it.

 

[Zzmed]

Guys, here is what I think (something that comes from my studying and your answers so far):

First thing to do: DISCUSS. As always. Talk to the kid. See what happens. Don't jump to conclusions right away, but don't take it slightly either, because forcing a kid to watch while parents are having sex is a pretty serious form of child abuse.
If there is a slight suspicion that something like this happened: Call child services + police. I wouldn't be so hesitant in reporting this like drdre above. Child Psychologists and stuff is where guilty parents want you to go. This comes afterwards, to support the child. Not something I would do first.

In a nutshell: We all need more clues and answer choices. But, here is what I would seek in the answer choices:
Discuss with the kid, see what happened--> report--> Psychs for the kid.

 

[Anastomoses]

Ugh. These questions are so tricky.

My first two concerns would actually be 1. Is this child being abused and 2. the other child...the sibling being molested...and whether child A - the 7 yo is a threat to the second child. In either case if I felt the answer "might" be yes, I'd call child services.

I probably need to get the Conrad Fischer 100 Cases book...

 

[Zzmed]

I probably need to get the Conrad Fischer 100 Cases book...

do it!

 

[Jonari]

Ugh. These questions are so tricky.

My first two concerns would actually be 1. Is this child being abused and 2. the other child...the sibling being molested...and whether child A - the 7 yo is a threat to the second child. In either case if I felt the answer "might" be yes, I'd call child services.

I probably need to get the Conrad Fischer 100 Cases book...

merry christmas!

http://www.slideshare.net/drazhar78...hics-the-100-cases-you-are-most-likely-to-see

 

[skyblue2000]

I'm guessing by this thread that FA isn't enough for behavioural... but kaplan just seems too long to do.

 

[Anastomoses]

merry christmas!

http://www.slideshare.net/drazhar78...hics-the-100-cases-you-are-most-likely-to-see

Looks like it's a very early xmas!! thank you! I love it. and it's just my size.

 

[Zam]

I'd refere the kid to a psychiatrist.
No one did anything wrong here, it's just a kid.