Expert MMI Response #8

In this situation, the issue is that while it’s important to respect and understand different cultures, I also have a duty to identify when a child is being harmed and call protective services if necessary. I want to make sure I understand where the patient is coming from, so asking questions about “cao gio” will be important to ensure I don’t inadvertently disrespect the patient or discourage them from seeking medical help in the future. Therefore, I would first ask for clarification on what the practice of “coining” is so I understand its applications from the mother’s point of view.

If a physician suspects child abuse, they have a legal and ethical duty to call child protective services immediately. If a physician fails to report abuse or fails to make the right decision for the child’s well-being, they are subject to legal sanctions by their college. Cultural sensitivity is another important caveat, as I will need to avoid unfounded reports that defame a patient and their culture.

After addressing the woman’s cultural background, I would take a moment to discuss the evidence with another colleague and ask them to validate or invalidate my conjecture. After getting a second opinion that confirms my initial suspicion, I would continue my investigation. I noticed the patient feeling pain when I touched the bruises, so I would ask him how he’s feeling and assess his pain/discomfort levels. If the patient says that he is actually feeling better than he was before, then this might contradict the idea that he is being abused. I also understand that because the woman stated that the procedure was to improve circulation and healing, she had good intentions, so I need to acknowledge the evidence for both sides to assess the strength of each claim.

I would begin to inspect how the child interacts with his mother. If he appears afraid of her or apprehensive, I will interpret this as evidence of abuse. If they seem to have a good rapport, this would also be evidence to the contrary. I believe that it’s best for physicians to stop a cultural practice when it threatens the health and well-being of the patient. This would risk alienating members of certain cultural groups, but physicians have a duty to advocate for their patients and act in their best interest, which means in a situation like this, it is not my priority to avoid entirely incidental defamatory consequences.

To summarize, I would evaluate the relationship between the patient and her mother, ask the mother questions about the procedure and her culture, and assess the child’s mental and emotional state to corroborate my suspicion that he is being abused, judging by the bruises on his body. If my colleague’s assessment is similar, I would call child protective services immediately. (465 words).

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