An evaluation of 'confirmatory' medical opinion given to English courts in 14 cases of alleged child sexual abuse.

Fourteen cases of alleged child sexual abuse, where the medical opinion rated a high degree of concordance with the history or suspicion of abuse given to the doctor, were reviewed to evaluate the objectivity and reliability of the medical evidence. It was common practice for physicians conducting the medical examination to form conclusions that the child had been sexually abused on the basis of the examiner's willingness to accept statements by the child, the adolescent, the caregiver or the investigator without determining if this information was accurate and obtained through the use of appropriate interviewing techniques. In the prepubertal children, evaluation of the examination findings revealed anatomical descriptions that were normal or non-specific, rather than supportive of abuse. In the teenagers, inadequate consideration was made of the behavioural and physical differences that occur with adolescence. The physical findings were not interpreted using research derived knowledge concerning the variations of "normal" and the particular conditions that may be mistaken as abuse. The medical reports of these examinations suggest to this author a possibility of the significance and relevance of physical findings being unduly and unwittingly over-emphasised, despite the cases all having occurred post the Cleveland Inquiry [Butler Sloss E. Report into the Child Abuse Enquiry in Cleveland, 1987. London, HMSO] and some as recently as 2005. This may reflect emotional involvement in the case and the doctor taking on a role of advocacy for the child. It is sometimes difficult for physicians to step out of the medical role where they do have the responsibility to diagnose and into a role where their information is only a piece of the puzzle and it is the work of the court to determine if sexual abuse has occurred. The role confusion between medicine and forensics must be sorted out in order for physicians to provide an objective assessment. The main conclusion of this paper is that it identifies significant training needs among doctors undertaking child examinations for suspected sexual abuse.