Definition
The word ‘paediatrics’ is derived from Greek words, pais or paido, which means child and iatria, which means medical treatment. Paediatrics is concerned with the physical, mental, emotional and social health of infants, children and adolescents and their opportunity to achieve full potential as adults. Unlike many other specialities, it is not concerned with one organ system or biological process.
In brief, it may be defined as Complete, Comprehensive, Continuing Care of children so that they become responsible citizens of the Country. (Note ‘C ’ s)
HISTORY TAKING
History taking is an art. It is learnt at bedside and the process of learning continues throughout the life. It is the most important of the three diagnostic tools, i.e., history, physical examination and investigations and it is often neglected or given less importance.
The history should be in detail, giving importance not only to obvious features but also to less obvious features. It is extremely important to know the concern of the patient or his parents in the case of a small child. For obtaining adequate factual history, one has to establish a “partnership” with the patient, based on honesty, empathy and respect. This will take the patient into confidence and one will be able to elicit information regarding sensitive issues.
The language forms an important means for communication, hence the paediatrician should be conversant with the patient's language including the local slang. Further, doctor should not forget the importance of patient's body language. Remember that clarity of the language goes a long way in communication.
The basic explorative questions include where? when? what? how? and why? and by appropriately and tactfully putting these questions, relevant answers may be obtained. A beginner can practice these while interviewing the patients. It has amply been emphasised by several senior physicians that the greatest medical books are “your patients”. Spend time with them, be with them, talk to them with concern, and learn clinical medicine but not clerical or computer medicine.
Three main types of questions that are often asked are:
- The open ended questions.e.g. “What happened next”?Such questions bring unbiased informations.
- Direct question.e.g. “Where is the pain”?These questions seek specific information.
- Leading questions.e.g. “That is what worried you, isn't it”?These leading questions may infact be misleading.
Where, when, what, how and why are your best friends in evaluating a patients symptoms. Remember to take factual history but not ritual. The seriousness of this last statement should be realised by every responsible student.
INTERVIEWING SKILLS
The main purpose of interviewing a patient is to explore the perception of another person, regarding his health, to make an appropriate diagnosis and help him. It is important that the “patients” concern or “parents” concern in the paediatric interview should be given the utmost importance. To understand concern, an orderly history and physical examination has to be done. A detailed history should be obtained and a doctor should be able to obtain “obvious” and the so called “less obvious” history. But he should use his discretion to give appropriate importance to the information he has gathered.
Always remember and aim at obtaining “Factual history” rather than “Ritual history”. Many young medical students and junior doctors lack this discriminatory power. This power comes only with “good experience” with abundant knowledge in the background. One of the important aspects of communication is language, an interviewer should know the patients language—even the local slang and appreciate his body language as well.
Always allow and encourage parents to talk and express their concern. Do not interrupt unnecessarily. Make them feel at ease and comfort so that more information comes. Use excess sensitivity while taking personal history, eliciting information with social taboos. A good doctor should be sensitive to the subtle as well to the obvious.
For many patients interview with a doctor is a moment of tension because: (1) They are curious about you, (2) They may be afraid of being told of a serious disease, or (3) It may be because of a gap in social, cultural, thinking level between you and your patient. Therefore, come to their level physically, emotionally and language wise, to make them feel comfortable.
Children need to be given a lot of attention but not “stare'; stare is always scaring, you may have to come down to their level both physically (even sitting on the floor) and emotionally (talking in language comprehensible by them, often they like fun). Talk to them gently, hold them affectionately, reassure them and praise them. An universal truth is that women and children 5like appreciation ! Then you may ask, what about men? Yes, they like ‘sympathy’!
Greater sensitivity has to be exercised while dealing with older children and adolescents; their modesty must always be respected. Many adolescents will be comfortable if private interviews are held. Sufficient confidentiality should be exercised in dealing with adolescent's problems.
Dress Code
A doctor should avoid extremes of dress and wear neat, culturally and socially accepted dress in your area. Many parents expect their doctor in a particular neat dress. “Children's doctor” should not wear white coat as most of the children get scared by seeing the white coat. A sensitive paediatrician should have the capacity to see the world through child's eyes.
Communication with Children—A Few Guidelines
- Be gentle in talk, actions and in look
- You may greet the child with “bye bye”, an indication to small children that the next step is “going”
- Be honest with children
- Show concern towards parents
- Use different skills at different ages
- In a busy Out Patient (OP), many barriers come in the way of establishing a good rapport, viz., the time, environment, language, local traditions and customs.
Communication with Adolescents
Build a Foundation
- Spend time together
- Encourage expression of ideas and feelings
- Respect their views
- Tolerate differences
- Praise good points
- Respect their privacy
- Set a good example.
Communicate Effectively
- Give individual attention
- Be courteous, calm and open minded
- Try not to over treat
- Avoid criticising
- Think through all options and make expectations clear.
MEDICAL TERMS
Many medical terms are so frequently used by medical men, most patients do not understand them but still pretend that they have understood. Some common terms and their meanings are as follows.
New but Essential Terms and their Definitions
Symptoms
Problems experienced by patient in relation to health and often identify underlying pathology.
Signs
Physical indication of disease, seen by anybody specially by clinician during examination.
Diagnosis
Cause of signs and or symptoms.
Prognosis
Predicted course of a disease.
Genogram/pedigree
Diagrammatic representation of family tree using standard symbols.
Activites of Daily Life (ADL)
To measure patient's level of functions.
Abbreviation
Accepted abbreviations should be used.
Sensitivity of Words
Sensitivity of the words used should not be underestimated.