Good doctor-patient communication is the cornerstone of high-quality health care. Everything from establishing trust to ensuring positive surgical outcomes hinges on how well providers and patients communicate. For doctors of pediatric patients, however, there are some unique challenges. Talking to parents of patients brings with it issues of health literacy, culture, and privacy. Here’s a look at some of the issues doctors who treat children and teens face, and how a thoughtful approach to patient education can help.
Why clear, simple language is even more important
In some ways, dealing with pediatric patients is no different than treating any other patient group. When speaking to patients and their parents, doctors should make a concerted effort to explain information as clearly and simply as possible, and to take the time to listen to patients’ responses.
Had she not asked if there were any questions, physician assistant Charishma Nayyar would not have discovered that her 10-year-old pre-operative patient did not understand the word “tissue,” which she used when describing his upcoming operation to his parents.
“Looking back, I could have chosen a different word when speaking to the family. Just because they were nodding their heads as I spoke, didn’t mean they necessarily understood. As I re-explained what was about to happen using plain language, all three family members got a better hold of what I had been trying to say,” Nayyar writes on KevinMD.com.
She notes that, “As a provider, it is easy to forget what it was like before medical jargon became our primary language,” but it is part of providers’ duty to ensure that everyone in the exam room understands what’s being said. Methods such as the teach-back technique can be effective ways to “test” patients’ understanding of what you’ve told them.
This is especially important considering that only 12 percent of U.S. adults have proficient health literacy according to a survey, reports the U.S. Department of Health & Human Services. Over a third of U.S. adults—77 million people—would have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart. Health literacy is an issue for all racial and ethnic groups, and even for people with strong literacy skills.
In some cases, a family’s particular cultural background plays a role in doctor-patient communication. For more on that, see our post, How Patients’ Culture Influences Health Care.
The two types of questions doctors must answer
Doctors of pediatric patients play a key role in helping prepare patients and families for medical procedures including surgery, notes an article in the journal Pediatrics. “The questions to be answered by the pediatrician fall into two categories. The first involves preparation … The second category concerns logistics.”
Thoughtful use of the right patient education materials can be extremely helpful to doctors, patients, and their families. By directing families towards web-based information and videos, doctors can educate patients on what to expect while freeing up their own time to focus on managing the patient’s medical condition.
On their website, Cincinnati Children’s Hospital offers a PDF booklet to download, “A Guide to Surgery for Patients and Families,” as well as a virtual tour of their facility. Anne Arundel Medical Center also offers a virtual tour from the perspective of a pediatric patient, as well as general pre-op guidelines for parents, broken down by a child’s age.
Again, it’s especially important for doctors to listen and ask questions in order to target patient education and avoid assumptions. For instance, in an article for the Washington Post on what doctors should tell parents who are afraid of vaccines, Kristin S. Hendrix, assistant professor of pediatrics at Indiana University School of Medicine, notes that parents may have different concerns than doctors think. Unless you ask, you may waste your time and patients’ discussing vaccine safety when their primary concern is actually whether or not the vaccination is covered by their health insurance.
Regardless of a family’s particular situation or decisions regarding their child’s health care, Hendrix urges doctors to remember “the common thread among all parents … is that they’re trying to do what they feel is best for their children.”
When to close the door on parents
Pediatrician Rebecca Weinshilboum notes that she spends the majority of her time talking to parents about their children’s medical needs—until her patients become teens. “With my teenage patients, the dynamic often takes a dramatic shift. I still talk at length with their parents, but at this age the most important conversations take place between me and my patients,” she writes.
She prefers to keep parents in the room as she tackles common adolescent health issues with young teens because she feels this facilitates discussions at home, she says. “But often, by the time patients turn 13, it’s time to encourage their parents to leave the room so that I can examine and talk with my patients in private. I let my teenage patients decide whether or not they want that privacy. Whatever they decide, I want them to understand that there is a level of trust and responsibility that comes with their age, which is reflected in our patient-physician relationship.”
Doctors of pediatric patients must navigate a different set of challenges than doctors who only treat adults. Fortunately, health care providers have more options than ever when deciding what tasks can be delegated to high-quality patient education materials, like pre-op instructions, and which require your undivided time and attention, like building trust with patients and their families.
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