Communication techniques used by pediatricians during well-child program visits: A pilot study

Abstract

Good communication between a parent and pediatrician may increase therapeutic adherence and the parent satisfaction. Therefore, a pediatrician's main goal during a consultation is obtaining and giving information.

Objective

To analyze occurrences during well-child program visits, specifically the communication techniques used by pediatricians.

Methods

We analyzed 49 visits to 5 pediatricians in Seville (Spain). To assure the visits were accurately studied, we audio-taped and transcribed them. To quantify the communication techniques used by pediatricians we developed a check list with 27 categories divided into 3 main communication categories for the visit; “concrete data gathering,” “narrative support” and “information and counseling.”

Results

We identified 2025 instances in which pediatricians used a communication technique, 1201 (59%) instances in which the pediatrician used a communication technique to gather information, and 824 (41%) instances in which they gave information and counseling. Pediatricians used a limited range of techniques to inform, counsel and give narrative support to patients. Significant differences among pediatricians were observed in the use of most techniques.

Conclusion

A limited range of communication techniques were observed. The lack of homogeneity among pediatricians suggests different styles of communication, depending on the quantity and quality of communication techniques used.

Practice implications

This finding can be regarded as a useful hypothesis and should be confirmed with larger pediatrician samples, as it would help to better understand consultation practices that may, in time, help improve communication with parents.

Introduction

Pediatricians are the main formal counseling source for parents about their child's development and education [1], [2], [3]. Pediatricians’ anticipatory guidance can improve outcomes of child health and development, including: infant vocal behavior, parenting skills, infant sleep patterns, parental use of discipline, language development, prevention of falls, home accidents, and auto-passenger injuries [4].

A family's knowledge and empowerment can be improved if mothers have the opportunity to express their concerns. This has been shown to have greater predictive power than most screening tests for the detection of both developmental and child behavioral disorders [5], [6], [7], [8], [9]. If a pediatrician acknowledges maternal concerns, it could be an important contribution toward early diagnosis.

However, several studies show that parents often do not receive all the information they need [10], [11], [12], [13], [14], [15]. They do not ask the pediatrician for information about their concerns because they perceive a lack of interest or time [16], [17], [18].

Communication is an important part of a patient's experience with healthcare services and greatly affects outcomes of care [19], [20]. Despite the growing awareness of the importance of good communication in healthcare, considerable problems, such as misinformation, lack of information and lack of responsiveness are among the most often reported complaints in studies regarding patient satisfaction [21], [22], [23], [24], [25].

However, most of the studies in this field are self-reported and do not allow any inferences to be made about the quality and quantity of the communication techniques used by pediatricians. Such information would help determine how much knowledge and training is needed to improve pediatrician counseling skills and to remove counseling barriers or to reinforce appropriate counseling practices [10], [26], [27], [28], [29], [30], [31].

To study the communication flow, it is useful to divide pediatrician visits into two main parts: the exploratory portion, in which the pediatrician obtains verbal information about the parents or the child and conducts the physical examination, and the solving portion, in which the pediatrician gives and discusses information with the parent and child, as well as offers counseling. Thus, since giving and obtaining information are the main activities of the pediatrician, having a basic knowledge about the interpersonal communication process may improve essential aspects of their practice [32], [33], [34].

In order to obtain information from parents, pediatricians should combine two techniques: those aimed at obtaining concrete data (concrete data gathering) and those aimed at facilitating the parents’ expression of interest and concerns (narrative support). There are a wide range of techniques for giving information and educating patients that substantially improve understanding and help patients follow recommendations [34].

Pediatric training in Spain is primarily focused on the diagnosis and treatment of diseases. Most preventative and educational activities represent a new experience for patients. In fact, topics such as child development and education or communication techniques tend to be secondary matters in the pediatricians’ initial training [26], [35], [36].

The aim of this pilot study was to analyze communication techniques used by pediatricians during well-child program visits. The visits are used to assess overall health, development, behavior, and family functioning, as well as provide parental education through age-appropriate counseling [4], [37], [38], [39].