Most pediatricians have experienced uneasy interactions involving patients and/or their parents. The majority of literature on this topic reflects encounters in adult medicine, without providing much information for pediatricians who also face this challenge. Unique to the pediatric approach is the added quotient of the parent/family dynamic. Patients or their parents may have personality disorders or subclinical mental health issues, physicians may be overworked or have a lack of experience, and the health care system may be overburdened, fragmented, and inundated with poor communication. Recognizing the physical or emotional responses triggered by challenging patients/families may allow the provider to effectively partner with, instead of confront, the patient or the family. In this article we review existing literature on this subject and describe possible strategies for the pediatrician to use during a difficult encounter.
Approaches to the Difficult Patient/Parent Encounter
COLLEGE STUDY ABROAD: A few weeks ago, my eldest son announced that he planned to spend next fall studying in Japan. While of course I was excited for him, part of me thought “Could you have picked a more expensive place to study?” The expense of college study abroad may be on the minds of lots of parents these days. As reported on USAToday.com (November 15, 2010:1–2), the number of U.S. students earning college credit abroad dipped in the 2008–2009 academic year. While not much of a dip, this is the first recorded decline in 25 years. Based on a survey of 3000 colleges, approximately 260,000 students earned college credit abroad during the same academic year. That is more than twice as many students who studied abroad 10 years ago, but still down from 262,000 the previous year. The U.S. recession played a large role in the decline. Families had fewer resources to pay for overseas study. Furthermore, the recession increased interest in new and oftentimes more affordable programs in developing countries. Although Europe is by far and away the most popular study destination, the number of students going to Europe dropped 4%. Enrollments in African and South American programs increased 16% and 13% respectively. According to the Institute of International Education press release, 15 of the top 25 destinations for study were outside of Western Europe. Money was not the only reason for deferring overseas study. The H1N1 epidemic and increasing drug violence both contributed to a 26% decline in U.S. students studying in Mexico. As for my son, he will be one of a small number of Americans in Japan, as Japan was not one of the top 25 destinations for college study abroad.
Noted by WVR, MD
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
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Cora Collette Breuner, Megan A. Moreno; Approaches to the Difficult Patient/Parent Encounter. Pediatrics January 2011; 127 (1): 163–169. 10.1542/peds.2010-0072
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