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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.
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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.
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Evidence-based studies show a direct association between the
physician’s competency with communication and relationship
building and health care 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.
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In this chapter, we briefly consider the evidence for enhancing
physician-patient communication, the concepts of patient-centered
and relationship-centered care, and several evidence-based frameworks
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.
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Why Learn Communication Skills?
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In one of the earliest research studies on physician-patient
communication,2 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.3 Studies
show that good communication between physician and patient correlates
directly with symptom improvement,4,5 better management
of chronic conditions,6 improved efficiency of
care including a significant reduction in diagnostic testing and
referrals,7 increased patient satisfaction8 and
adherence,9 greater physician satisfaction,10 and
fewer medication errors11 and malpractice claims.12 The
majority of malpractice claims arise from communication errors.13
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In pediatrics, effective physician-parent communication is associated
with parental satisfaction with care, adherence to treatment recommendations,9,14 and
enhanced discussion of psychosocial issues.15 Parents
highly value physicians who attend to both their and their child’s
feelings and concerns16 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,17 and parents’ perceptions of
the physicians’ interpersonal sensitivity, partnership
building, and ability to provide information.16
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Psychosocial issues motivate 65% of primary care pediatric
visits, and 85% of mothers with young children indicate
they would welcome or not mind ...