The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.
—Sir William Osler
Despite the extraordinary scientific and technological advances in modern medicine, the core skills and sine qua non for the delivery of quality pediatric health care remain those of skillful communication and building and maintaining therapeutic and caring relationships with children, adolescents, and their families. The quality of the relationship with the child and family affects all aspects of patient care—the diagnostic process, treatment decisions, adherence with recommendations, and both patient and physician satisfaction.
Evidence-based studies show a direct association between the physician’s competency with communication and relationship building and healthcare quality and outcomes. Good communication between physicians and their patients improves the physician’s diagnostic acumen and promotes more efficient, accurate, and supportive interviews. Most physicians agree that good communication with their patients is a desirable goal.
In this chapter, we briefly consider the evidence for enhancing physician-patient communication, the concepts of patient-centered and relationship-centered care, interpersonal and communication skills, a framework for enhancing attention to values in healthcare interactions, and several evidence-based models for communication and relational skills. We examine specific strategies and techniques for communicating and building relationships with children and families throughout the pediatric interview. The overlay of children’s understanding of illness and the related developmental stages of childhood are presented.
Why Learn Communication Skills?
In one of the earliest research studies on physician-patient communication, pediatrician Barbara Korsch described communication lapses in the care of children in an emergency department. The central tenet of her groundbreaking paper, that communication is an essential factor in quality of care, is supported by numerous evidence-based studies, including the Institute of Medicine’s 2001 report Crossing the Quality Chasm. Studies show that good communication between physician and patient correlates directly with symptom improvement; better management of chronic conditions; improved efficiency of care, including a significant reduction in diagnostic testing and referrals; increased patient satisfaction and adherence; greater physician satisfaction; and fewer medication errors and malpractice claims. The majority of malpractice claims arise from communication errors.
In pediatrics, effective physician-parent communication is associated with parental satisfaction with care, adherence to treatment recommendations, and enhanced discussion of psychosocial issues. Parents highly value physicians who attend to both their own and their child’s feelings and concerns and who seek to understand their perspective. Greater parent satisfaction with care is positively associated with more active communication between physician and child, adequate attention to parental concerns regarding the child’s illness, and parents’ perceptions of the physicians’ interpersonal sensitivity, partnership building, and ability to provide information.
Kahn and colleagues found that psychosocial issues motivate 65% of primary care pediatric visits, and 85% of mothers with young children indicate they would welcome or not mind being ...