A Doctor's Decision: Whether or Not to "Call the Cops"
A most interesting scenario was posted on Medpedia by Scott M. Dyck which I am, in part, reproducing here but you might want to go there to review the responses there but also feel free to make your comments here. If you were the doctor in this case, what would you do? ..Maurice.
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.
posted by Maurice Bernstein, M.D. @ 9:47:00 PM
9 comments
9 Comments:
That's a tough decision. This mother doesn't sound abusive at all, her intent is probably good. Obviously, however, the result is not. Parents make many mistakes, and just need to be educated, not reported. I suppose the decision might be based upon her reaction to a discussion of how this practice is harmful.
TAM
What is the ethnicity of this family - are they Hmong? First-generation immigrants? All cultures have their own beliefs and medical practices, and I'm not sure it's a good idea to come down heavy-handed without first obtaining more facts. Especially if they are relatively new immigrants and don't have health literacy in the sense that we define it. To them, coining may be a perfectly acceptable thing to do, and any attempt to reach out to them could well be destroyed by calling Family Services or law enforcement.
If a child is being harmed, clearly you can't let it go unchallenged. But if cultural differences are part of the issue, it behooves us to tread a little carefully.
I'd recommend reading "The Spirit Catches You and You Fall Down."
- the crabby skeptic
I don't believe this is a tough decision, as doctors should have a sense of diversity towards a more multicultural society. As this is a traditional method where it is used as a theurapetic means to improving health, it should not be considered as a case of child abuse. If we compared the bruising of this child (from the coining) to a scar of another child (from surgery), could we say that the child does feel a little bit of pain from both situation, but it does make the child become healthier in the long run. If child abuse is a concern, the doctor should ask the patient to come again in a week or in 2 weeks, to see if the abuse signs are there, but I don't believe there is a need to call the police because getting the government involved in cases like this is unnecessary and could result in consequences that are more harmful to the child and the family that could have been prevented.
But where is the beginning and end of abuse? Is it defined by the first word "trauma" or "injury" and the last words "without consent or assent"? Do the words "intentional" rather than "unintentional" play some role in its definition?
And what about the part of the world where the act is taking place and the customs and laws of that part of the world? Can the act of "cao gio" be lawful and non-abuse in, for example, Viet Nam whereas "coining" in Kansas U.S.A. be something altogether the opposite?
..just wondering. ..Maurice.
I think intent has some importance, as someone who is not intentionally causing harm can be educated, instead of punished.
As far as coining being helpful - well, one has to abide by the laws of the country one is in. If scientific evidence here does not support this as being helpful, and it is causing bruising (harm), then I think it is not lawful.
But, again, I would suggest educating the parent, not punishing, as a first resort.
TAM
A visitor wrote the following response today. ..Maurice.
I agree to everyone else. It is a tough decision to make as the mother just wanted to make her child feel better. However, it is more appropriate if the child is brought to the attention of medical professional. This is just another procedure of “home treatment first” which often fails as parents have lack of knowledge about this kind of situations. Maybe, the doctor should educate the mother about this and not to do similar things again.
I do not believe CPS should be contacted. Different cultures have different practices. She tried her method, it did not work, so she brought the child to modern med dr. I think patient education is what she needs. So Dr. What is YOUR answer??? ☺
Personally and as a physician, I would like to know all the facts. One fact that can be obtained would be to go to a resource who has had more experience, perhaps legal experience than my solitary occurrence. That first resource would be to communicate with Child Protective Services since the organization may have much more experience within our social community than myselbuf with regard to this issue. My goal is not to report to the organization but to learn and use that learning and perhaps from other sources before I decide to make or withhold a formal report. Obtaining and understand facts relative to an issue whether it be medical or social should be the first approach to coming to a decision.
That, Cathy, would be mu "answer". ..Maurice.
There are many people who still believe in superstition. These people must understand that was a thing of past they must move on.
Post a Comment
<< Home