BUILDING THE PATIENT AND PAEDIATRICIAN RELATIONSHIP

By Chan Lilian

Looi is devastated and shocked that her 2 yrs old son is diagnosed with some developmental delay problem recently. As a mother, she suspected something is amiss with her child’s behaviour. So she decided to seek the opinion of a child psychiatrist in a private hospital, and consulted a neurologist in a large Government teaching hospital for a second opinion. When I asked if her child has been under the care of a regular paediatrician since birth whom would have noticed the problems, she lamented, “My paediatrician ...mmm...we just visit him for the normal cold and cough and jab sessions. No monitoring of my child's progress at all, no questions asked, in fact we are the one who are asking the questions...unlike what is mentioned in the books where the doctors actually monitor the progress of the child. I feel cheated!”

Looi is not the first parent I met who is upset with her child regular caregiver. A relative of mine also encountered a situation where her grandson was given treatment, which is less than satisfactory from a large private clinic. The child has shown obvious signs of some developmental problems but surprisingly, the medical professionals did not detect his condition until much later. Recently, I was also told of a baby who was born blind but his regular medical caregiver failed to noticed until his parents brought him to another paediatrician who discovered it.

Apart from these rather serious conditions, there are also gripes from other mothers whose children have the common childhood illnesses. Some of the usual statements are “In the past 6 days, we have been to 4 paediatricians. Yet, my girl is not getting any better.” or “I took my child to a few doctors and they tell me different things.”

All the above gripes about their respective doctors made me wonder - Is there a communication breakdown between these parents and their medical caregivers? Most of the mothers that I mentioned are highly educated and can afford specialists care in private hospitals. They would have equipped themselves with a certain amount of knowledge related to baby/childcare and their health through reading extensively from books, magazines, literatures and the internet. Therefore, they may be able to make some informed decision. Then why are they left with the feeling that they are not getting the kind of medical attention they expected?

What then can a mother do to make sure that she gets the optimum medical attention from her child’s doctor? A mother spends all the time with her child whilst the paediatrician spends only minutes. Looking at this situation, how the doctor diagnoses a condition will then greatly rely on the mother’s observation and explanation. I have 14 years experiences of taking care of my five sons, including one who was an oxygen-dependant baby and another who is asthmatic. Through my consultation with the numerous medical professionals in the last 14 years, I have learnt various tactics and techniques to ensure that I receive the kind of service I expected.

With some experience, common sense and guidance, a mother can learn to differentiate the common illness from the serious ones. Being the primary caregiver, she would be able to note the symptoms and condition of her child before she even bring the child to the doctor. Therefore, mothers will help greatly if they jot down some of their observation like the child’s temperature, changes in eating pattern, bowel movement, discomforts expressed by the child or any out of the ordinary behavior and provide them to the doctor during consultation. At the same time, it will be helpful if they also jot a few questions beforehand to ask the doctors.

In a paediatrician clinic, usually the queue and waiting time are long because of the number of patients. Coupled with the stress of dealing with an irritable, whining and ill child, one tends to forget many things. Moreover, one can feel being rushed through a doctor’s visit. Thus, in that few moments in the paediatrician office, a mother may not be able to concentrate fully on the communication with the paediatrician. Hence, the notes and questions will come in very handy. A kind and friendly doctor will not hesitate to entertain an occasional follow-up phone call or two from the mother. She may be unduly worried because her child’s condition did not improve but getting worse upon returning home. Therefore, a mother will save the hassle of consulting several doctors for one illness which is term as ‘doctors shopping’.

On the other hand, doctors ought to be given the chance to follow-up with their diagnosis and treatment. If we bring our child back to the same doctor, it will ensure that he receives a more comprehensive check-up and attention. Some illnesses may not be diagnosed and cured with just a single consultation and a bout of medicine. At times, the illness will naturally progress to other problems. This does not necessary mean that the earlier treatment is not effective. It merely means that the patient needed further treatment for the subsequent condition.

A first visit to the paediatrician office can be a harrowing and terrifying experience for both mother and baby if the child is sick or needed the schedule injection. Much tears and screaming will result out of a situation deemed foreign and frightening to a child. Further, the mother may be too worried and overwhelmed by the condition of her child and impending treatment. Ideally, an expectant mom will have carefully selected a paediatrician prior to the birth of her child. She can do this by finding information about the location of the clinic, facilities available, operating hours, procedure like whether an appointment is required and also the reputation of the doctor from friends. It is worthwhile to take time to look around for someone the mother is comfortable with because the child will be under the care of the selected person for his first 15 years of life.

Another helpful point in ensuring that our children get the optimal care is to attend routine checks in the well-baby clinic. The aim is for child health surveillance, which is regular health and development checks for young children to see that they are growing and developing normally, and for early detection of any health problems so that they can be treated early.

Well-baby clinic is not only available in private hospitals and clinics, but also in the Government sector. In Malaysia, the Maternal and Child Health programme conducted by the Ministry of Health, carries out health screening at local Maternal and Child Health Clinics (KIKK). These clinics mainly deal with immunisation and basic growth monitoring and nurses / assistant nurses / midwives carry this out.

Some of the advantages of attending well-baby clinic are:

1) Your child is well and thus, the doctor can record an accurate reading of his weight, height, head circumference and other measurements to chart his growth. The doctor will also observe the developmental milestones and responsiveness of the child. Though this may seem trivial and unnecessary expenditure, having a well-recorded chart can be an important factor to determine the health and growth of the child.

2) Your child is not likely to be crying or whining and thus, it gives you a chance to have a better question and answer session with your doctor.

3) You will have the opportunity to discuss about teething, nutrition, development and other issues related to childcare. This way, you will have a clearer guidance from your doctor and that gives you more confidence in your child rearing.

4) Your child will not associate that doctor with being sick and uncomfortable or someone who administer painful treatment and scary examination. It will develop a much more pleasant relationship between child and doctor. If a child’s fear of doctor is allayed, future trips to the doctor will be less stressful to the mother and child.

5) In a more relaxing environment like this, you will have a better judgment on the responsiveness of the doctor. If you are not comfortable with the communication, then you will be able to decide if you need to change a paediatrician. You can do so in an unhurried pace compare to the moment when you child is already ill and urgently needs medical attention.

Our Malaysian genial and polite manners sometime make us reluctant to ask too many questions from people we deemed more superior than us, in this case, someone who knows more about our child’s health. Some paediatricians have chided me when I make demands for certain medication, test or treatment because in their wise opinions, it is unnecessary. However, as a mother who is genuinely worried and concerned about my child well-being, I usually insist for very detailed and satisfactory explanations before I will agree with their opinion. Then again, many first time mothers have told me how their doctors have brusquely brushed off their anxieties as over-reacting. Or a doctor who conveniently tells my friend who has an ADHD child that he will outgrow his condition without offering her the necessary support in dealing with a hyperactive son like a referral to a specialist dealing with this condition.

A good patient/doctor relationship should have no barriers where asking questions and voicing concerns are related. If you are not truly satisfied with the doctor’s decision or explanation, never be bashful to ask him/her for referral to other specialist in another field. Sometimes, doctors communicate in medical jargons, which if interpreted wrongly can cause unnecessary fears and worries. Therefore, repeat your understandings to your doctor in your own words and see if it concurs with what was explained.

A mother is most concerned about her child. Throughout the childhood years, there are bound to be a few inevitable trips to the doctor’s office. Therefore, it is wise to see that your child’s medical caregiver is someone whom you trust and can rely on.