I haven't been doing Paeds long enough to be an expert on writing this kind of stuff, but suffice nevertheless for my standard; as far as I'm concerned. You know how in daily routine of a doctor who works in Child's Health Department, he/she has to interact and deal with people from all walks of life. A bit like in General Practice and A&E I supposed.
The mix varies tremendously; ranging from neonates (clearly cannot speak) to infant (incomprehensible babbling) to toddler (mismatch sentences) to young child (very curious lot) to adolescence (unique behaviour --> can't really generalized them) to of course lovely (not!) parents. And then we have parents of different educational background, social class and dynamic with their child. Then there are kiddies who are unlucky enough to have speech delay for any reason.
Some doctors really do portray an image of a good communicator with the children. Really pitching it down to the kiddies level. In a rather cute and super friendly way, not putting up a humiliating act. For example: "touch your nose, touch my nose" -directing a child in a sing-song voice while testing for cerebellar function. Some just can't be asked: which make me wonder why bother being a Paediatrician if you genuinely hate kids?
Addressing a child as a Fraser's competent being (talking/asking the child to explain rather than going straight to parent) is a good way of building up rapport with the child. Ok, possible not the non talking kiddies. That's fair enough. But for toddler who can understand what we mean, I would definitely advised approaching the child first as an autonomous being. Plus, it is much fun hearing a child trying to explain him/herself. "I had pain here... my mom gave me calpol. She said I have temperature. I dont think I have temperature".
It will make a big different I think if a child is treated as an autonomous person. A doctor can try to include the patient in the management. For example: "Do you think you can go to the loo 7 times a day?" Patient will feel that the doctor has put some degree of trust in her/him. "Yeah, I'll try, I'll let you know how it goes....next time I see you" (real case of management of daytime wetting in an 8-y-o girl).
Then while doing the physical examination, please don't medicalized the test. Alter it into a child-friendly step. I think the best way is to demonstrate it on ourself. Like this: I want you to blow into this paper like this (then proceed to show how). With the tendon hammer or the stestoscope, let the child touch it first. (real case of a child who cried upon seeing the tendon hammer as she was afraid that it gonna hurt her). Let them know that its not gonna hurt. Seriously. Sometimes we as an adult forgets.
Adolescence. Hmm... been there, so I perfectly understand what exactly they are going through. Of course every other doctors had gone through the same phase of life. So we all should know how difficult it is to be a normal teenager, let alone teenager with (embarrassing/chronic) medical condition. "My friends think I'm a freak show as I inject myself (with insulin) at school" (again real case). Personally I like to share a personal story/ experience when talking to teens. "I remember times when I was called a freak too. Just because I wore braces at that time". Its all about making the teenage patient comfortable in speaking to you.
Its a tough call I know and I wont stop improving myself. Promise.
Today a patient opened up to me and another medical student about her past history. She was raped (!!!!!!! I couldnt believe what I was hearing at that time; utterly shocked) 3 yr ago and the her Paediatrician doesnt even know about that (Presenting complaint: a year hx of unspecific abdominal pain, missing school and learning difficulties). Talk about shocking news!!! I guess she must have found it easier to tell us about her problem.
That was a really good eye opener.
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