Pediatrician-Parent Communication in a Continuity-of-care Setting

Abstract

This study investigated pediatrician-parent communication by content, analyzing medical encounters in a setting providing continuity of care. Thirty-eight encounters between middle class families and three senior pediatricians were audio-taped, transcribed, and analyzed for content. The categories of medical communication coded from the interactions were related to each family's medical and demographic characteristics. Five patterns of results emerged: (1) There was a highly stylizied active-passive role relationship, with doctors asking twice as many questions and making twice as many commands as the parent did. (2) A strong reciprocity norm existed between pediatricians and parents for the communication of affect. (3) The higher the experience, income, and educational levels of the parents, the shorter the encounters were, the less frequently symptoms were discussed, and the more frequently medication and professional treatment were mentioned. (4) Parents discussed health more in terms of organicity of causes than did pediatricians who, more frequently, raised environmental factors. (5) The more the family had a history of past illnesses, the more frequently the doctors made affect comments during the encounters. Comparing the results to findings drawn from an emergency clinic documented the importance of sustained relationships between practitioners and patients.

Patients' Perceptions of Medical Encounters in Great Britain: Variations With Health Loci of Control and Sociodemographic Factors

“…In fact, we reported that patients in lower social classes agreed most strongly that their doctor did not respond well during the consultation. This supports earlier reports, by Arntson and Philipsborn (1982) and Waitzkin (1984), both of which were based on research conducted in the United States. These researchers found an inverse relationship between patients' social status indicators and the amount of information their doctors offered during the consultation.…”

“…In the United States, both Arntson and Philipsborn (1982) and Waitzkin (1984) reported an inverse relationship between patients' social status indicators and the amount of information their doctors offered during the consultation. We are interested in determining if this pattern holds true in Great Britain as well.…”

How Physicians View Caregivers: Simmel in the Examination Room

“…However, patients do not ask the questions necessary to receive information (Beisecker 1988(Beisecker , 1990Beisecker and Beisecker 1990). Compared to parents, doctors have been shown to ask twice as many questions and make twice as many demands in medical interviews (Arntson and Philipsborn 1982). Because there is a lack of questions, the doctor, not knowing that the patient desires information, does not offer it (Waitzkin 1984).1 Prompting parents to talk about their children's health concerns led to increased discussions of child health topics during medical interviews (Finney et al 1990).…”

Maternal attributions of etiology in nonorganic failure to thrive.

“…In addition, when attributing causes to a variety of childhood problems, parents are more likely to attribute deficiencies to the child than to see themselves as ineffective caregivers (7, 9). Arnston and Philipsborn (2) found that middle- and upper-middle-class parents more frequently described a range of pediatric health problems in terms of organic causes than did their doctors. Such findings suggest that parents may have a generalized bias toward labeling organic (rather than environmental) causes of anxiety-arousing child problems.…”