Journal of General Practice

The General Practitioner and Children of Separated Parents in Belgium: A Qualitative Study and its Implications

Abstract

Kacenelenbogen N, Roland M, Schetgen M and Dusart AF

Background: Many children are experiencing their parents’ separation and General practitioners (GPs) often have the responsibility to medically follow these young patients. Objectives: The goals were to identify the main difficulties GPs are confronted with when following children of separated (or divorced) parents and to find ways to improve the quality of these children’s continuous medical monitoring. Methods: Eight focus groups of GPs were organized in 2004 in the French-speaking Community of Belgium. Each meeting focused on couples separated for less than three years, with children aged 0 to 15. The debates were analysed with the QSR N5 software. Data saturation was obtained after four focus groups. Results: The viewpoint of GPs is: 1. Divorce affects the working conditions of GPs. 2. Conflicts between the parents cause difficulties for the GP, particularly the fact of being « exploited » by the parents. 3. All GPs do not have the same attitude towards conflicts between the parents; only some of them will try to « manage » the conflicts to improve the child’s situation. 4. Especially in the case of conflicts, parental separation brings a risk for the child: psychological disorders, physical health problems. 5. The professional attitudes of GPs can have a positive influence on the child’s development, including direct child-centred communication with the child. 6. Some actions, such as producing sickness certificates or official reports of neglect, can aggravate these children’s situation, especially in the case of conflicts between the parents. Discussion: Parental separation could be an independent risk factor for the child’s health by inducing some difficulties of tracking in primary care medicine. If this is confirmed, in case of a family breakdown, the GP should adapt the practice of prevention and care, recognizing young patients as most at risk. In order to confirm the possible impact of family status, cohort studies must be conducted either transverse observational targeting unselected paediatric populations of different ages, or even better in prospective research. Given the high prevalence of parental separation in Belgium, the influence of these situations should be measured in terms of public health.