Study Suggests How Pediatricians May Improve Relationships with Patients and Their Parents

Researchers recommend strategies for physicians when relating to particularly stressed or overburdened parents

Stressed parents, physicians needing improvement in communication skills, and a health care system fraught with economic pressures can sometimes lead to difficult encounters between pediatricians and the parents of young patients. According to numerous studies looking at patient/provider relationships in adult patient populations, nearly one out of six outpatient visits in adult practice is considered difficult by physicians. Until now, it has been unclear how this may relate to pediatric practice. In a new study looking at factors affecting pediatricians, led by Cora Collette Breuner, MD, MPH of Seattle Children’s Research Institute, researchers have identified factors in pediatric settings that may contribute to difficult patient/parent encounters. The findings also suggest strategies to improve the pediatric provider/patient/parent relationship. The study, “Approaches to the Difficult Patient/Parent Encounter,” published online December 20 in Pediatrics.

“In pediatrics, physicians need to interact not only with patients, but also with their parents. This adds additional layers of complexity. Understandably, parents may be both very dedicated to and strained by caring for a child with ongoing major needs, for example,” said Dr. Breuner, pediatrician at Seattle Children’s Hospital. “When we can more effectively partner with parents rather than confront them, we increase the likelihood for better compliance with recommended care. Ultimately, we hope this improves the patient’s care and outcomes.”

Based upon data from existing health information databases, Breuner and co-investigator, Megan Moreno, MD, MSEd, identified factors that may contribute to difficult patient/parent encounters in pediatric care. They found that interactions between physicians and parents in pediatric settings can be especially difficult if a parent: has an abrasive or threatening demeanor toward the physician; does not comply with prescribed treatments or medications for their child; or suffers from a mental illness.

Parents of children being treated for chronic illnesses may be considered particularly challenging by some physicians. This group can be especially vulnerable and stressed, since they cope with a very ill child on an ongoing basis. On the physician’s side, the researchers found that those who were younger and with less clinical experience may be more likely to perceive some parent encounters as difficult.

Other contributors leading to difficult parent/provider relationships included language barriers, cross-cultural issues and poor physician communication skills. Additionally, these factors can lead to undesirable patient health outcomes, complaints and lawsuits. Overbooked clinics can also contribute to patient/parent dissatisfaction.

To help improve difficult encounters, Drs. Breuner and Moreno recommend that physicians seek training in additional coping and communication techniques. Understanding patient and parental expectations is associated with improved patient compliance, and can reduce the complaints and fears that may accompany serious illness. They also recommend that physicians consider modifying scheduling systems to increase the time spent with some patients and their parents as increasing patient/parent involvement in the process of care delivery may enhance the provider/parent relationship.

Breuner’s study collaborator was Megan Moreno, MD, MSEd, of the University of Wisconsin, previously affiliated with Seattle Children’s Research Institute.

About Seattle Children’s

Seattle Children’s Hospital, Foundation and Research Institute together deliver superior patient care, advance new discoveries and treatments through pediatric research, and raise funds to create better futures for patients. Consistently ranked as one of the top 10 children’s hospitals in the country by U.S. News & World Report, Seattle Children’s Hospital specializes in meeting the unique physical, emotional and developmental needs of children from infancy through young adulthood. Through the collaboration of physicians in nearly 60 pediatric subspecialties, Seattle Children’s Hospital provides inpatient, outpatient, diagnostic, surgical, rehabilitative, behavioral, and emergency and outreach services to families from around the world.

Located in downtown Seattle’s biotech corridor, Seattle Children’s Research Institute is pushing the boundaries of medical research to find cures for pediatric diseases and improve outcomes for children all over the world. Internationally recognized investigators and staff at the research institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention, bioethics and much more.

Seattle Children’s Hospital and Research Foundation and Seattle Children’s Hospital Guild Association work together to gather community support and raise funds for uncompensated care, clinical care and research. The foundation receives nearly 80,000 gifts each year, from lemonade stand proceeds to corporate sponsorships. Seattle Children’s Hospital Guild Association is the largest all-volunteer fundraising network for any hospital in the country, serving as the umbrella organization for 450 groups of people who turn an activity they love into a fundraiser. Support from the foundation and guild association makes it possible for Seattle Children’s care and research teams to improve the health and well-being of all kids.

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