In article <[log in to unmask]>, Rob Johnson
<[log in to unmask]> writes
>The Question I really need a consensus about is " What is the definition
>of the word likely" in the above sentence.

My thanks to the 10 people who responded to this question.  I had hoped
for a larger response but the replies did demonstrate to me that this is
not such a strait forward question as I had perceived.

My rational is that if you use the word 'likely' to describe an event
then the opposite would be unlikely and there is nothing in between.
Thus I would argue that for an event to be likely there must be a
probability of >50%.  This argument was not accepted by Social services
and I had hoped to present a medical consensus from this group.  2
people supported my view but the others all started at a much lower
level.  The lowest being >5%.  

The case in question was about a child who sustained a fracture that
occurred with minimal trauma and with an explanation that was accepted
by the Hospital.  The skeletal survey showed a periostial reaction in
another long bone.  There was a lot of debate as to whether this was a
normal finding or an indicator of another fracture.  10 days later,
after further x-rays and various discussions, it was finally concluded
that it was almost certainly another fracture.  A  S47 investigation was
held by social services and came up with nothing of concern.  The
parents were very distressed that the "Professionals" believed that they
had abused their child and asked the Paediatricians if there could be a
Medical explanation.  Their question fell of deaf ears.  Knowing that
they had not caused the fractures they went in search of an explanation.
The baby had very obvious Blue/Grey sclera and they wondered if this was
Osteogenesis Imperfecta.  The local paediatricians had failed to
establish a relationship of trust with the family and were unwilling to
get involved in reassessing the child.  The family finally took the
child to Scotland to see Dr Patterson who confirmed this as a typical
case of Osteogenesis Imperfecta Type 1A.  At the case conference the
paediatricians advised conference that Dr Patterson's opinion should not
be accepted. (It is difficult to explain the reasons for this without
risking a libel action).  It was decided that a Paediatric assessment
was needed to decide on the diagnosis and that until that had been done
then the child's name should be added to the Register under the category
of "Actual Physical Abuse".  The reason they gave was "As there is an
unresolved issue, further injury is likely".  This conclusion was
reached despite statements by all the people that knew the family well,
namely myself, the health visitor, the police and the school, that they
did not believe that further injury was likely.

Two weeks later after a Paediatrician from another unit had confirmed
the diagnosis of Osteogenesis Imperfecta the child's name was erased
from the Register.

I complained to Social services that the decision to register was
inappropriate and had caused the family tremendous emotional pain.  My
complaint was dismissed on the grounds that "Further injury was likely"


For those of you that have got this far, I would appreciate your
thoughts.


Rob.

THIS DOCUMENT IS INTENDED FOR DISCUSSION WITHIN GP-UK ONLY

Dr R I Johnson
The Family Practice, Church Lane, Sleaford, NG34 7DF
Tel. 01529 305595 Mobile 0378 206475 Fax No 01529 305589
Single handed GP. Send email to [log in to unmask]


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