Thinking Out Loud

Mom and the Pediatrician

First, the story: A mother and her five-year-old daughter go to a check-up with the pediatrician, who has an intern with him. The little girl has not been to the doctor’s office for several months and is usually reserved when she is there, deferring to her mother for communication with the doctor. In fact, the girl hardly utters a word. The story ends with the doctor suggesting to the mother that she consult a speech and language pathologist. The mother replies, “I don’t think that’s necessary.” The doctor is quietly disapproving as the appointment moves along and he talks mostly to the intern. He never asks the mother why she thinks the consult is unnecessary.

The mother didn’t think the consult was necessary because her daughter spoke in complete, complex sentences (and paragraphs) at eighteen months, with excellent articulation. The child recently turned five and reads picture books, with the punctuation marks guiding her voice inflections. She also writes.

It’s easy to pick on the pediatrician for his obvious and, frankly, outrageous error, but our purpose here is to look at communication—what works and doesn’t work, and why. We also will not address the time and money issues that are relevant in establishing good communication practices in medicine. Most medical practitioners do not have (and would like to have) enough time to adequately attend to their patients because of the reimbursement system.

Parents often need to have discussion with their child’s doctor without the child present. While there are many logistical complications that make this hard to achieve, it is important. Without this opportunity, there is too much cryptic conversation between parent and doctor or none at all because of the child’s presence in the exam room.

It would be helpful for parents to let the doctor know of questions or concerns that would best be discussed privately before going to an appointment. At the end of the appointment a similar opportunity should exist. This could be fostered by the use of other office personnel. Research has shown that good communication and rapport between doctor and patient effects treatment compliance and outcomes—a real health issue—not just a feel-good issue.

Good pediatric medical treatment means working with both the child and parents. Without adequate communication structures in place the whole child is not being treated properly. Pediatric medicine has a good reputation when it comes to prevention and having a strong developmental orientation. Developing good communication practices would only strengthen the care children receive.

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