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Changing facets of Doctor- Patient- Parent relationships

editorial 7.1It is often talked that the medical profession is not the same now as it used to be. Good students and good teachers do not prefer to join the medical profession anymore. However, in several parts of the world, parents still respect and trust the advice of the doctor as the doctors are considered semi Gods while in other parts, the parents are very demanding. To establish a good rapport, a good communication in health care is needed. It revolves around interpersonal relationship building with mutual respect, trust and empathy. Communication is an art. With experience and knowledge it is not difficult to build confidence, achieve purposeful information and reach at trustworthy diagnosis and have a long lasting relationship. It should be realized that the patient and the parent have the right to know about the problem and the expected outcome with intervention or management.

As the information is easily available and accessible on the internet these days, most parents are equipped with the knowledge on problems their child may be facing. It is important for the doctor to handle such cases cautiously. The advice given by the doctor is taken with suspicion and is cross checked at all levels. The words of the doctor are compared with the material on the net, and sometimes even the clinical expertise and experience of the doctor is not of much help to satisfy the parents fully.  

The problem is less acute to explain the gravity of situation in complex cases in emergency, with no insurance cover, poor socio-economic background, illiteracy, and the child being precious, and it may be a lengthy discussion with a difficult couple with inadequate knowledge, who would be curious to know everything possible. This chang-ing trend is making the doctors more vulnerable to scrutiny.

The issue of the patient being a child is more sensitive. While communicating with patients, doctors need to remember that children are not just small adults. Doctors dealing with children should adapt some paediatric communication skills like whispering to distract the child, keeping toys and puppets, making funny faces, avoid frowning while reading reports or radiographs. Children are much attuned to facial features and frequently associate frowning with a problem. They may become more worried, scared, and tense. Use of soft words helps to create a congenial environment, like Appearance instead of Deformity, Wonder instead of Worry, Take a picture instead of Shoot an X-ray and Finding instead of Problem. Only the most needy and the relevant investigations should be asked that too after discussing their importance with the parents or the pa-tient. A sudden prescription of battery of investigations without examination and evaluation of the patient may prove catastrophic.

Various support groups operating worldwide are aiming to bridge the gap of ignorance and understanding, especially in the field of congenital adrenal hyperplasia, disorders of sexual development (DSD), spina bifida, neuroblastoma, Wilms tumor and trauma. The DSD support groups as a community of individuals, families and allies are actively collaborating to even make their presence felt at important international scientific meetings like WOFAPS and ISHID. These groups need to be handled carefully with scientific reasoning so as not to hurt their feelings.

Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. Though open communication about the disease is regarded as the best policy for child and parents as it leads to an improved knowledge and understanding of the illness, and decreases anxiety and depression. Information in paediatric oncology, however, is generally complex, emotionally charged and needs to be communicated softly and slowly. Parents/ young patients tend to prefer a collaborative role in medical decision making and agree on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed.

The doctor–patient relationship in general practice is often viewed by practitioner and patient alike as a long-term “personal” relationship. When a child grows up with a chron-ic problem, the relationship with the doctor matures and when the patient grows up enough to hand over to an adult specialist, the termination should be done in a phased manner so that the adolescent is comfortable with the new doctor.

A confidentiality needs to be maintained at all times especially when matters of disorders of sexual disorders, hypospadias, cryptorchidism, tumors are dealt with that may affect the patients future life, sexual relationship, fertility and relationships with the partner. Proper education, insurance cover to the expecting mother, antenatal diagnosis of the malformations, a mutual trust and proper communication by the treating doctor would at least reduce, if not completely remove these problems due to the unfavour-able change in this trend. Teachers should serve as the role model and mentor their students so that they learn the ethos, culture and discipline and good interpersonal relationship.

 

 

Devendra K. Gupta

MS, M.Ch, FAMS, Hon. FRCS (Edin & Glas), FCSS, D.Sc (H.C)

Vice Chancellor: King George’s Medical University, Lucknow. UP India

President: World Federation of Associations of Pediatric Surgeons