Letter: Medico-legal problems if there is no examination

Dear Editor

I would like to comment on the advice that 'from a medico-legal perspective, all children must be examined in the presence of their guardian,' (GP, 16 December 2005).

I would argue that, from a medico-legal perspective, the interests of the child are paramount. Therefore I assume that an examination could be conducted without the presence of a guardian if this could be justified as being in the child's best interests? I agree that an appropriate chaperon and careful documentation would be essential.

Even in the apparently non-urgent case of a child with a genital rash, it could be argued that a brief examination would be in the child's best interest before sending him home with advice to re-attend later.

Without an examination, how confident could you be that the 'rash' wasn't cigarette burns, bite marks, erythema from torsion or infection or even a petechial rash of early meningococcal disease?

Moreover, what would your medico-legal position be if you missed serious pathology through failing to examine?

Dr Sean Allen, Worksop, Nottinghamshire.

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