The McColgan report comments on the general practitioner's effectiveness in handling allegations of child abuse which were disclosed to him. The expectations of the McColgan children at the time, and the trust they placed in his ability to deal with their situation, reflect a general attitude that doctors are all-powerful and all-knowing about such matters.
The report recommends closer liaison between family doctors and the child-protection system. Yet the question must be asked whether the assumption that the GP is "expert" in these matters is a realistic one.
When child abuse was "discovered" in the 1960s, and defined in terms of the "battered child syndrome", medical practitioners were placed in the central position of identifiers and managers of this "disease".
However, recent years have seen a shift in doctors' status in this area, as the knowledge base on child abuse has expanded. Research in Britain, and a study conducted by this author in an Irish health board region, confirm the low rate of diagnosis of child abuse by GPs. In the Irish study, they referred just 5 per cent of the total number of child-abuse cases reported to one community care area over a six-month period.
In none of these cases were doctors the prime "identifiers" of alleged abuse: in each situation the concern had in fact been brought to them by the child's parents or by a non-medical professional. Why, when doctors are in such close contact with families, are they so apparently slow to identify and report child abuse? One reason is sheer lack of information. Other impediments include, firstly, the fact that business in a doctor's surgery is conducted at a rapid pace and opportunities to get more than a "snapshot" of a child's emotional state or relationship with his or her parents are limited.
Secondly, physical and emotional neglect or unusual behavioural symptoms do not feature in GPs' continuing education programmes with anything like the frequency of, say, diabetes or kidney disease.
Thirdly, the relationship between a GP and his or her patient is enshrined in a type of ownership, based on notions of "his patient" or "my doctor". None of these elements of the doctor/patient contact is likely to facilitate the sort of negative interpretation of information from parents that would lead to an allegation of child maltreatment.
The most common forum for the integration of inter-professional child-protection work is the case conference. In the Irish study, GPs attended only 20 per cent of the case conferences to which they were invited. Lack of time was an important factor, though British research shows that even when GPs are given a choice about time their participation is still significantly low.
Remuneration is another issue. At the time the Irish study was carried out GPs were paid approximately £23 for what could take up to three hours of their time. In the market economy operated by most independent practitioners, this clearly represents poor value for money.
Is it not the case then that the expectation underpinning the McColgan report's recommendations of a willing and committed partnership between GPs and the statutory child protection system is somewhat erroneous?
As statistics imply, they are not necessarily in a good position to identify child abuse, and their willingness to participate in the system seems to be hampered by ethical concerns about confidentiality and family privacy.
Such professional norms are not congruent with the sort of approach deemed necessary to address actual or potential child abuse. Would it not be fairer to refrain from assigning GPs a central, "vital" role in an area where they appear to be less than comfortable?
Dr Helen Buckley is a lecturer in the department of social studies, and co-ordinator of the Advanced Diploma in Child Protection and Welfare, at Trinity College Dublin