1. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Parents’ experience with their sick child and us – the GP’s

2. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Communication means in general to exchange information in an attempt to change someone else's conviction – or action. What is communication ?

3. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice From newborn the baby is able to communicate Fivaz-Depeursing&Corboz-Warnery 1999 From the age of seven month the baby uses the crying as a communicative signal in a attempt to control the parents Papousek 1993, Wolff 1969 When can children communicate

4. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Triadic consultation

5. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Why did I make this study? One night working on emergency duty

6. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice To investigate and uncover parents' experience with and understanding of the child's illness To discuss possible misunderstandings in the communication between the parents and the physician Research Questions

7. Nordic Congress of General Practice Copenhagen May, 2009 389 Birth cohort 194 Participated: Filled in a diary for January, February and March and a questionnaire 20 Interviewed Methods

8. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice The parents' main concern was whether observed behavioural changes in their child were signs of illness Specifically they wondered what these signs meant and how serious they were What parents feel, see and do

9. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice They questioned the physician's expertise if their concern was at odds with the physician's interpretation and response to the child's illness In particular if the physician said that ‘the signs will disappear' 'it’s nothing' 'it’s a virus ' Observations at the physician

10. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice... ” Virus, that's a pretty worn-out word used by doctors, it can't be true that everything can be a virus – a sore throat, that's just a virus. It is such a nice explanation of things. You damn well don't need to study for so many years to become a doctor, one can inoculate oneself with those colours there”

11. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice The communication gap seemed to widen if the signs had been going on for a long period or if the children did not seem to thrive, in which case the parents seemed to be really confused and frustrated Worst – case secenario

12. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Theoretic background GP’s explanatory models Parents explanatory models Signs of illness

13. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Explanatory Models 'are the notion about an episode of sickness and its treatment

14. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Patients sometimes used the same biomedical explanations as the physicians, but their biomedical explanations were often incomplete and sometimes wrong from a physician's biomedical point of view Patients typically focus on the most salient aspect, which is the treatment of the illness. Patient s have no sharp boundaries between the ideas and the experience of an illness. Patients conceptualise illness in many different ways and these conceptualisations frequently change according to the illness

15. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Conclusion Parents experienced that the physician did not acknowledge their sensitivity and 'common sense' response to the child's signs of illness They felt judged as incompetent by the physician if they visited with symptoms that the physician considered minor or emotional They experienced that their observations and anamneses of the child's illness episode(s) were not taken seriously and rejected with phrases such as 'it will disappear' or 'it is a virus' They experienced that the physician was not able to figure out why their child continued to suffer from recurrent illness. The parents felt the lack of a specific and concrete diagnosis and effective treatment of their child

16. Nordic Congress of General Practice Copenhagen May, 2009 Parents of children with recurrent illness should receive extra attention and carefully planned information Conclusion Challenges in communicating with children and their parents in general practice

17. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice to explore the parents’ illness experience and avoid giving the parents a feeling that their initiative is inappropriate. to investigate the context around the sick child and the family to give information about the child’s symptoms and tell about how you evaluate the child’s symptoms and the severity of the illness. To improve the meeting between the parents and the physician the physician could try:

18. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice obtain an agreement about treatment / no treatment to contribute to the parents’ own attempt to cope with the situation Remember that the parents have to make decisions based on behavioural changes or minimal body signs and they have a great knowledge of their child as they had been communicated since the baby was 3 month old. To improve the meeting between the parents and the physician the physician could try:

19. Nordic Congress of General Practice Copenhagen May, 2009 Challenges in communicating with children and their parents in general practice Parents cope with a lot of illness incidents with their small children without consulting me, so when they do contact me, they really need my help Parents have exerted themselves in observing the child’s symptoms and communicate the illness complex to me, which I then can dismiss or confirm if the symptom complex requires treatment. I recommend parents with a recurrently ill child to take a 2 to 3 months sick leave so the child may recover and the family as a whole may get some rest and regain their energy. Which impact has my PhD thesis had on my own clinical everyday as a GP

20. Thank you for your attention