Confronting my own ignorance

I was a second year paediatric trainee working in our walk-in clinic when I was asked to see a 3-year-old boy from Africa with a rash. After a quick examination, I met with my supervising resident to discuss the case and told him that I was sure the patient had been abused. There were six to eight round ecchymotic bruises on his back. The parents did not speak English and could provide no good explanation for the bruises. The family was reported to social services. One week later I was informed that the patient had been subject to ‘cupping’, a type of health remedy.

There have been a number of recent reports that detail the impact of race and type of hospital on the reporting of children suspected of being abused.1 2 These are disturbing variations, since many professional societies have produced evidence-based recommendations that certain injuries are consistent with abuse and that clinicians should report children with such injuries to the appropriate authorities. Variation in reporting clearly reflects how individuals – for whatever reason – interpret these recommendations.

Variation in reporting of child abuse highlights the potential importance of a paper …