Dias nummer 1

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Parents experience with their sick child and us
the GPs
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What is communication ?
Communication means in general to exchange
information in an attempt to change someone
else's conviction or action.
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When can children communicate
From newborn the baby is able to communicate
Fivaz-DepeursingCorboz-Warnery 1999 From
the age of seven month the baby uses the crying
as a communicative signal in a attempt to control
the parents Papousek 1993, Wolff 1969
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Triadic consultation
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Why did I make this study?
One night working on emergency duty
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Research Questions

• To investigate and uncover parents' experience
  with and understanding of the child's illness
• To discuss possible misunderstandings in the
  communication between the parents and the
  physician

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Methods
389 Birth cohort
194 Participated Filled in a diary for January,
February and March and a questionnaire
20 Interviewed
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What parents feel, see and do

• The parents' main concern was whether observed
  behavioural changes in their child were signs of
  illness
• Specifically they wondered what these signs meant
  and how serious they were

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Observations at the physician

• They questioned the physician's expertise if
  their concern was at odds with the physician's
  interpretation and response to the child's
  illness
• In particular if the physician said that
• the signs will disappear'
• 'its nothing'
• 'its a virus'

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... Virus, that's a pretty worn-out word used by
doctors, it can't be true that everything can be
a virus a sore throat, that's just a virus. It
is such a nice explanation of things. You damn
well don't need to study for so many years to
become a doctor, one can inoculate oneself with
those colours there
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Worst case secenario
The communication gap seemed to widen if the
signs had been going on for a long period or if
the children did not seem to thrive, in which
case the parents seemed to be really confused and
frustrated
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Theoretic background
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Explanatory Models
'are the notion about an episode of sickness and
its treatment
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Patients sometimes used the same biomedical
explanations as the physicians, but their
biomedical explanations were often incomplete and
sometimes wrong from a physician's biomedical
point of view   Patients typically focus on the
most salient aspect, which is the treatment of
the illness. Patient s have no sharp boundaries
between the ideas and the experience of an
illness. Patients conceptualise illness in many
different ways and these conceptualisations
frequently change according to the illness
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Conclusion

• Parents experienced that the physician did not
  acknowledge their sensitivity and 'common sense'
  response to the child's signs of illness
• They felt judged as incompetent by the physician
  if they visited with symptoms that the physician
  considered minor or emotional
• They experienced that their observations and
  anamneses of the child's illness episode(s) were
  not taken seriously and rejected with phrases
  such as 'it will disappear' or 'it is a virus'
• They experienced that the physician was not able
  to figure out why their child continued to suffer
  from recurrent illness. The parents felt the lack
  of a specific and concrete diagnosis and
  effective treatment of their child

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Conclusion

Parents of children with recurrent illness should
receive extra attention and carefully planned
information
Challenges in communicating with children and
their parents in general practice
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To improve the meeting between the parents and
the physician the physician could try

• to explore the parents illness experience and
  avoid giving the parents a feeling that their
  initiative is inappropriate.
• to investigate the context around the sick child
  and the family
• to give information about the childs symptoms
  and tell about how you evaluate the childs
  symptoms and the severity of the illness.

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To improve the meeting between the parents and
the physician the physician could try

• obtain an agreement about treatment / no
  treatment
• to contribute to the parents own attempt to cope
  with the situation
• Remember that the parents have to make decisions
  based on behavioural changes or minimal body
  signs
• and they have a great knowledge of their child as
  they had been communicated since the baby was 3
  month old.

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Which impact has my PhD thesis had on my own
clinical everyday as a GP
Parents cope with a lot of illness incidents
with their small children without consulting me,
so when they do contact me, they really need my
help Parents have exerted themselves in
observing the childs symptoms and communicate
the illness complex to me, which I then can
dismiss or confirm if the symptom complex
requires treatment. I recommend parents with a
recurrently ill child to take a 2 to 3 months
sick leave so the child may recover and the
family as a whole may get some rest and regain
their energy.
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Thank you for your attention