Do you know why the parents are concerned? Why not? #WILTW

This is the 146th #WILTW

When one of my team presents a case to me I obviously want to hear about the history, examination and suggested plan for the child. Within the history I am looking for the answer to a vital question:

What is the parent really concerned about? 

This is a key teachable moment even though it might seem inherently obvious. Clearly any health care professional would want to find out why a patient had been brought to hospital.

Wouldn’t they?

Well it’s worth pausing for thought here. The presenting complaint is not the same as parental worry. A baby may present with a history breathing difficulty and reduced feeds, they may examine with no other finding than a running nose. But what the mother is truly worried about is whether her baby will stop breathing when she goes to sleep at night. Some families will tell you this up front, but not all will. Sensitivity is key to finding the best management options for the family.

Fever phobia is the most obvious manifestation of a symptom that masquarades as a complex set of health beliefs. A child may be completely well appearing, in fact laughing and smiling during the consultation, but if the families cultural instinct is that fever causes you great harm, they will be fearful out of proportion to their child’s appearance.

Many symptoms: diarrhoea, vomiting and fever in themselves are of little consequence. They indicate the presence of illness rather than its severity. I am far more concerned when the parent can’t explain to me what they think is wrong with their child: “They’ve had a cough and cold, a bit of fever. He even vomitted last night. But he’s not right, doctor, he’s just not right

Parents and carers have never been more aware of the grave consequences of some diseases but the risks of succumbing to those same illnesses are probably the lowest they have ever been. As our most serious diseases become rarer they will be even more difficult to spot if attendances for other conditions increase.  Without truly listening, and educating, we are probably perpetuating the very problem we are trying to solve.

What have you learnt this week #WILTW

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  1. I totally agree with this approach and it is often the first question ask when I am asked to review a patient. The registrar may have taken a great history, done the best physical exam and come up with an exam worthy discharge plan but the parents remain unsatisfied.

    Finding out the real worries of the parents, taking time to listen and validate their concerns is a great way of creating rapport, re-inforcing the importance of safety netting and reducing the possibility of un-necessary re-attendances.

    Great work, Damian.

  2. Thanks Andy. It’s an interesting phenomenon when you get a first class recital of a clinical consultation but the parents are very frustrated when you go and seem them. Not always the initial doctors fault but patterns of communication behaviour do quickly emerge in some individuals.