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Hard choices


Dr. Graff acknowledges that it takes time, effort and clinical skill to evaluate childhood injuries. But, he says, "You cannot justify sending away an injured child with a discrepant clinical history just because he looks great and has a normal CT." He also points out that when providers file a report of suspected abuse, it doesn't necessarily mean the child will be removed from the home.

"That's up to the county and law enforcement," he says. "That's why providers have to be very specific about the injuries and the concerns that go with those injuries. Just filing a report may not mean much to a deputy. What we say and how we say it can send a message that may affect decisions that are made."

It's also imperative that providers recognize their own biases. Studies have repeatedly shown that minorities and people from lower socio-economic backgrounds who present to the ED are far more likely to be accused of abuse than white, middle-class families are.

"Anyone is capable of hurting a child, from the governor to a pastor or physician, and providers cannot let their biases color their evaluations," Dr. Graff says. The grandchild of Mayo's CEO should be treated the same as the child of a street person. If we follow that philosophy, we'll provide better medical care to all people."

Providers who have questions about difficult cases can contact the Mayo Clinic Child and Family Advocacy Center 24 hours a day, seven days a week. "If you can't decide whether to file a report or are wondering what X-rays are needed, pick up the phone. We're a good resource, and we're here to help," Dr. Graff says.