Primary care
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Child abuse is a common pediatric problem that can be recognized and treated appropriately by all primary care physicians who care for children. One of the necessary skills in this process involves being prepared to interface with the legal system. The physician is mandated to report suspected child abuse according to his or her state laws. ⋯ Finally, the physician may be called to testify. An understanding of how to prepare for court and how to conduct oneself in court is the final necessary skill for the primary care physician who sees children. This article provides the primary care physician with a practical understanding of the legal considerations in child abuse.
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Clearly, there are numerous troubling variations in the medical diagnosis of child sexual abuse. These variations include delays in disclosure; rapid healing; maturational changes; variations in normal congenital findings; the technique of the examiner; patient position, relaxation, and cooperation; and additional medical conditions that mimic abuse. ⋯ Emphasis on the child's history in documenting the abuse is increasing. As physicians, we must develop interviewing techniques that will assist in child protection, and we must listen and believe the comments made by our patients.
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Because physicians are often the first professionals to have contact with a sexually abused child, they must be alert to the symptoms and prepared to respond knowledgeably. Early and effective intervention affects the overall prognosis for the child and family positively. As physicians become aware of child sexual abuse, protocols can be used routinely as part of a child's medical care. Regular checks on potentially abusive situations can prevent the tragic and traumatic occurrence of child sexual abuse.
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Domestic violence is an enormous health care issue that primary care physicians are powerfully suited to address. Rarely, however, do primary care physicians recognize that many of the patients who regularly and routinely present to them are victims of abuse. This article is designed to empower America's front-line doctors to recognize and appropriately treat the many victims of domestic violence who currently suffer from this silent epidemic. The reader will come to understand that it is via relatively simple-to-learn techniques that physicians can significantly impact the health and well-being of their communities.