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Determining the Link Between the Doctor and the Patient

While sitting in my doctor’s office one day, I came across an interesting article. The

article told the story of a ten-year-old girl born with a rare disease that featured unusual

symptoms. One symptom from this disease was paralysis in a single leg. The girl and her parents

were flown out to see a specialist. Upon meeting with the patient, the doctor found it difficult to

properly examine her. The patient was unable to sit still and was rejecting assistance. The doctor

tried multiple techniques to calm the patient down verbally. With each unsuccessful try, the

doctor was getting frustrated with the patient. The doctor tried to use the parents to assist with

patient cooperation. The doctor decided the best course of action was to reschedule the

appointment and try again the following week. Upon returning the following week, the doctor

asked the parents “How is she doing since her last visit?” The parents responded by saying “No

change in her symptoms or behavior.” The doctor was at a loss on how to further proceed. I had

just started getting to the interesting part of the article when I heard the nurse announce my

name.

Taking the article with me into the exam room, I spoke about it with my doctor. We had a

conversation in regards to the proper way to handle complex patients. I mentioned a few things

that got my attention while reading the article. He used personal anecdotes to help me see things

from a different perspective. We talked about what got me hooked on this article. I mentioned

about a school project I was assigned. This assignment requires each student to find a topic of

interest and research a specific question. I told him what my topic was. I thought this article

would be a good starting point for my question. We spent the next few minutes discussing

possible ideas for my topic and research question. I asked my doctor if he would be willing to

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help with my assignment. The two of us crafted a topic and question based around the article I

had presented to him.

For my assignment, I wanted to look at what determines a good example of a doctor-

patient relationship. Using my previous experiences with doctors, I wanted to find out if others

had similar experiences. I always viewed my doctor visits as productive and beneficial. My

doctor would utilize time and answer questions that I had. My doctor was able to do full

examinations on me from a young age. I can recall only seeing the same doctor every single

time. This allowed me to build a layer of trust with my doctor. The above mentioned article

made me reflect on the relationship I’ve had with my doctor. I hope by gathering this

information I can advise other patients to develop quality relationships with their doctors. This

led me to my own research question: How does the patient and doctor connection in pediatrics

affect the speed of recovery in children?

The American Academy of Pediatrics defines pediatric medicine as “a discipline that

deals with biological, social, and environmental influences on the developing child and with the

impact of disease and dysfunction on development” (Hotaling et al). This is the definition that is

commonly accepted by prominent doctors. Other definitions have been created and used over

time. A pediatrician is a term for a primary care practitioner who chooses to specialize in treating

children and infants. They are responsible for the health, welfare, and development of children.

To be a pediatrician requires four years of medical school, plus an additional year(s) of

specialized, intensive training solely devoted to all aspects of medical care for children and

adolescents.

Current healthcare trends are showing hospitals are in need of doctors who specialize in

pediatrics. Statistics currently show pediatrics as having the second longest waiting time at

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hospitals. A majority of children’s hospitals are showing vacancies in positions and are having

difficulty finding qualifying candidates. Studies rank pediatrics as having one of the highest

shortages in positions needed for the ability to deliver care. Pediatric specialty shortages affect a

family’s ability to receive timely, appropriate care. Hospitals are always looking for candidates

to fill these vacancies. These lack of positions cause waiting times to grow larger and decrease in

the amount of time patients can interact with their doctors.

A shortage of pediatric specialists has created burdens on the American medical system.

US Medical schools are struggling in filling the voids on specialties like pediatrics due to a lack

of federally funded programs. Most schools are funding the general education completely, but

not specialties. To help fill the void, medical programs need to fully fund specialties such as

pediatrics. The AAP (American Academy of Pediatrics) states that residencies in pediatrics are

funded for the first 3 years, and not longer than that.

Research shows that the development of skills needed to work with younger patients is a

difficult one to quantify. Some studies will try and show the most common trait for proficient

pediatricians. Quality doctors need to rely on other skills such as clinical decision making, past

experiences, knowledge and cultural understanding in order to be deemed effective. Usually the

types of people who enter pediatrics do so because of the fascination with children. The prospect

of working with kids are able to put parents at ease. Doctors enjoy working with kids of varying

ages because of the different skills needed. Each age level brings with it different joys and risks.

Each kid has their own personalities and quirks. Even though some kids have difficulty with

language, doctors still are able to find an appropriate means of communicating with them.

One study looking at effective communication skills performed by doctors was done by

Wu. The study looked at the nine most common steps doctors use in order to be comfortable

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around pediatric patients. Some of the common themes found in this study were: “confidence,

encouragement, adaption of style or approach, friendliness, expression of interest, making the

experience as enjoyable as possible, prior contact with child (if possible), small talk, use of toys”

(Wu). By having read this study, a greater understanding of the needs of adolescent patients was

understood. This study explained the mindset of how doctors approach children and their needs.

Children are perceptive and can catch certain nonverbal cues. Children can pick up on signals

from their doctor. For instance, if a doctor is showing some sort of emotion, there is a risk that

the child begins to act out in that similar emotion. Children tend to be more comfortable with a

doctor who acts in a friendly manner and tries to make the experience as painless as possible.

Children who are able to see the same doctor on a regular basis will feel more comfortable in the

exam room. The child learns to trust the doctor and to follow their advice closer.

The process for working with newborns and infants are a critical time in a child’s

experience. The possibility of developing trust between the patient and the doctor starts here.

From an early age, children have difficulties in verbalizing pain and rating pain on a scale. From

the beginning, the relationship between a family and the doctor needs to be established. The

parents need to have confidence in the skills that the doctor provides. They need to make sure

that both parties are fully in agreement with specific courses of action. This can only be achieved

by developing strong partnerships and having trust in the field of pediatrics. Through a child’s

development, the responsibility for developing the doctor patient connection relies heavily upon

the parents. They are the ones responsible for selecting the hospital, the doctor, the treatment

plan, and all other decisions.

Studies show the process on how doctors work with newborns and infants. Many doctors

have conflicting ideas or theories as to whether infants can feel pain. Some clinicians say that, “a

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two-month old baby doesn’t feel pain. They said children who don’t anticipate pain don’t feel

pain” (Watts 149). Infants are thought to have higher sensitivity for pain than adults in certain

situations. Because infants have this higher sensitivity, doctors need to be able to recognize this

and be able to treat accordingly. They need to be able to use the proper forces and movement

patterns to effectively perform their exams. They need to be able to position the child in certain

poses to achieve necessary screenings. Doctors need to be able to test a newborns reflexes and

other neurological conditions.

For a doctor to be considered “quality” they need to utilize certain skills that are difficult

to teach. Some people have these skills and are able to use them often. A small percentage of

people have been known to acquire these through clinical experiences and through practice. One

such skill needed by doctors is empathy. The dictionary defines empathy as “the ability to sense

other people’s emotions, coupled with the ability to imagine what someone else might be

thinking or feeling” (de Waal). This is just one example of empathy. Different doctors will use

empathy in a variety of ways. Some doctors will tell personal stories as a way of connecting with

their patient. Other clinicians will be more direct and to the point when discussing specific

conditions. When a clinician works with kids, they need to use a combination of techniques and

emotional engagement when dealing with the comfort and care of their patients.

Besides empathy, competent pediatricians must display an awareness of cultural norms

and ideals. Certain cultures have preconceived beliefs on topics within the medical field. Capable

doctors must rely on their education and training and experiences to be aware of specific cultural

norms. These can include the concept of vaccines versus no vaccines, circumcision versus no

circumcision. Other beliefs can include life saving measures such as blood transfusions, organ

transplants and other surgeries. A third potential topic can be the discussion of gender whether its

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male or female practitioner. Race or a language barrier can be an issue that clinicians can run

into. Other things can be home remedies and or specific cultural medicinal uses. The local

community hospital has taken several of these steps outlined above to be culturally appropriate

when dealing with pediatric patients.

To gain an understanding of how pediatricians use some of the skills from above, I went

and spoke with a doctor at Kaiser Permanente Medical Center in Walnut Creek. My visit here

left me feeling warm and welcome. The staff made me feel appreciated and complimented my

outfit. The receptionist had a bright smile and a cheerful personality. Our interaction was short

and direct to the point of the purpose of my visit. Upon walking into the pediatric area, I saw a

few TVs with cartoons playing. I also saw other families with kids in the crowded waiting area. I

saw tables stacked with various toys and books positioned near the door. Against a wall stands

an aquarium with a variety of tropical fish inside. The waiting room smelled of cleaning solution

and made me sick. I felt like there was too much bleach used and it was overly sanitized. The

color of the walls reminded me of the bottom of the ocean with a mix of greys and blues. The

next thing I remember was sitting down in my hard plastic leathery chair and taking my phone

out to read a book. I was in the process of getting to the good part when the medical assistant

called out my name. She asked me how my day was, how it is outside, and asked me how I’m

feeling. I gave the person a couple of quick words without thinking about it. We walked towards

the exam room and I was instructed to sit on the exam table. Upon glancing around the exam

room I noticed the color of the walls. They were two different shades of blue, and they had

different Disney stickers displayed all across the walls. These stickers are designed to calm down

the child and to keep them focused on the task at hand. Other things around the exam room that I

noticed was a desktop computer which the doctor used to take notes on. The position of the

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computer was away from the patient’s line of view so that I had a direct line of communication

with him. The doctor and I went through my relevant medical history. He was constantly asking

me a series of questions regarding my health. I was focusing on his reactions and noticed him

gazing up at me every few seconds. The pediatrician never failed to amaze me by being able to

answer all of my relevant questions and was thorough with his responses. He knew exactly what

things to say to get an appropriate reaction from me. I left his office feeling much better and

knowing I was on the right path to recovery. Each experience that I’ve had with my doctor has

made me think about interviewing my doctor for my school assignment.

First I emailed my doctor and briefly mentioned my assignment and what I needed to do

for it. I explained to him what my research question was and the best process to answer it. After

speaking with Dr. Randy Bergen, we decided to schedule an interview together that worked for

the both of us. Dr. Bergen was the chief of outpatient pediatrics from 2006-2015. Knowing this

fact, I was certain that he would have the right information and be able to help me with my

research question. Dr. Bergen was always a clinician I looked up to because of the interactions I

had with him. He has been my primary care provider since I was born. He understands my

medical history better than anyone I trust.

While doing the interview with Dr. Bergen, he was able to bring up several good points

that steered me towards my research question. We spoke on several different topics. He had

mentioned numerous things that I felt were relevant to my question. One specific point that was a

recurring theme was the importance of establishing a connection with a parent. He stated that it

was important to send a child home with instructions on how to manage the specific condition.

One example he gave of instructions that he gives to a parent is, “As a pediatric doctor, it is more

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important to connect with the parent than it is with the patient because with a child it has to do

with sending the parents’ home with instructions about how to take care of the child.”

Other topics that came up during our interview were how to interact with younger

children. Due to inconsistencies in the child’s response, the doctor often has to rely on the

parents to get a fuller picture of what happened. This is often due to the child being unable to

respond. The parent must have a good understanding of their child’s symptoms and reactions to

pain and discomfort. The parent must be able to communicate appropriately with the doctor so

they can perform the correct exam and give out the necessary advice. The doctor needs to use

proper judgement when discussing a child’s medical condition with the parent. The manner in

which they speak can have a positive or a negative influence on the child. The doctor needs to be

certain that they are careful in how much information they present to the parents while in front of

the child so as not to frighten the child. The interactions between a child in an office setting and

an ER are often different. I learned that, “If a child is present in an office visit, which they almost

always are, providers should limit negative talk about the child” (Lerwick). Pediatric doctors

have to ensure that the parents are up front and honest with the diagnosis from the get go.

Ultimately the decision on how to proceed lies with the parents and the doctor. The child does

not have much in the way of decision making. Most of the time, the parents are the ones who are

making the most difficult decisions when it comes to the care of their child.

To dive deeper into my research question, I reached out and spoke to a pediatric physical

therapist. We spoke about my research topic. We spoke about in regards to how she uses

empathy and cultural norms in her daily routine. The name of the pediatric physical therapist I

spoke with is Michelle Daly. She has her own clinic and works with patients at her house in

Clayton, CA. During our interview, we collectively decided to focus on several topics: the

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patient therapist connection, the healing process, and on the rate of recovery. She explained how

positive and or negative interactions with the therapist can affect healing outcomes. We spoke

about examples of negative connections from her practice. One example of a negative interaction

that we spoke about involved a child with Down Syndrome. She spoke about the negative

experience and listed some examples of other negative patient therapist connections. She talked

about parental interference in therapy sessions, or when a parent undermines the therapist’s

efforts to have the child move independently. We spoke about the positive examples from her

practice. We talked about how these interactions affect the rate of recovery. We spoke about

motivation, both internal and external and its effects on the patient therapist connection. Most of

her stories were more anecdotal in nature rather than more scientific and polished. She has

looked for articles as evidence and has been unsuccessful in finding the connection between

improved healing and liking of the therapist.

After speaking with Daly, I learned about the challenges parents can face when dealing

with certain health conditions. I learned about her methods on how she deals with complex

medical conditions. I learned what steps she takes to ensure that her patients have positive

interactions. Having spoken with Daly, I learned new strategies and skills that I hope I can

someday apply in all of my interactions. We spoke on the topic on best practices for interacting

with toddlers and with other young patients. I learned strategies on how to deal with difficult

toddlers and underdeveloped children. We talked about strategies that she uses for dealing with

difficult parents. We briefly touched the subject of cultural differences and how to navigate those

complex issues.

Establishing the patient therapist connection as a factor in recovery was one method used

to get the most out of that group of children. Having a positive connection with a child can lead

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to greater compliance and ensure that the exercises are being done regularly and are challenging.

One example of a positive experience that I found through my research, “bi-weekly play therapy

appointments, giving the toddler control and power in the playroom by inviting her to direct her

own play” (Lerwick). One example of a negative therapy experience would be laughing or

making faces at the child while they struggle learning a new skill. The consequence of this

negative interaction can have long term consequences on the child’s development moving

forward. Therapy sessions for children can be stressful and the last thing a therapist wants to do

is cause additional stress for the child.

When I came up with this research question I was surprised by the lack of concrete

evidence I could find. It seemed like an important topic that was not being covered in the

resources I was using. I knew that I would have to think outside the usual route with this topic. I

knew that I would have to break my topic down and piece it together to get a satisfactory answer.

The more research I did, the more this topic fascinated me. I gained an extra level of appreciation

for the medical field and the connection created by people. I would like to use some of the skills

I learned to parlay this into my adventures into the healthcare field. I hope to continue looking

into this topic and being able to use the information I have learned to be a better clinician and a

better person overall. The task I found most challenging was appropriate research for my topic. It

seemed to me that most of the research I came across was anecdotal and had very little use to me.

I found it difficult in understanding how to apply the anecdotal evidence to my everyday

interactions with my research. I learned some useful strategies and tips on patient doctor

interactions and the effects they can have on many factors.

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Works Cited

Book Sources:

Mitchell, Silas Weir Doctor and Patient. J. B. Lippicott Company 2005

Watts, David Bedside Manners. Crown 2007

Electronic Sources:

"American Academy of Pediatrics Guidelines for Treating Behavioral Disorders in Children with

Ritalin Ignores Evidence of Cancer Risks Warns Samuel S. Epstein, M.D." PR Newswire,

4 Oct. 2001. Student Resources in

Context, http://link.galegroup.com/apps/doc/A78904449/SUIC?u=wal55317&xid=d1811

708. Accessed 28 Feb. 2018.

de Waal, Frans. “What Is Empathy.” Greater Good, 1 Sept. 2005,

greatergood.berkeley.edu/topic/empathy/definition. Accessed 21 April 2018.

Hotaling, Andrew J. “Definition of a Pediatrician.” Pediatrics, vol. 135, no. 4, 30 Mar. 2015, pp.

780–781., doi:10.1542/peds.2015-0056. Accessed 21 April 2018

Leary, Warren E. "HEALTH: Pediatrics; Progress in Treating Children's Pain." New York Times,

17 Nov. 1988. Student Resources in

Context, http://link.galegroup.com/apps/doc/A175998724/SUIC?u=wal55317&xid=15cd

59d9. Accessed 28 Feb. 2018.

Lerwick, Julie L. “Minimizing Pediatric Healthcare-Induced Anxiety and Trauma.” Minimizing

Pediatric Healthcare-Induced Anxiety and Trauma, 8 May 2016. Accessed 5 March

2018.

Slowinski, Susan. “The Doctor-Patient Relationship.” Brattleboro Memorial Hospital,

Brattleboro Memorial Hospital, 22 Jan. 2018. Accessed 5 March 2018.

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Wu, Brian. “Connecting with Pediatric Patients.” Student Doctor Network, Student Doctor

Network, 6 Jan. 2016. Accessed 5 March 2018.

Primary Sources

Randy Bergen, Chief of Outpatient Pediatrics, Kaiser Permanente Medical Center Walnut Creek,

Personal Interview: Date: March 8, 2018

Michelle Daly, Pediatric Physical Therapist, Email Interview Date: March 8, 2018

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Works Consulted

“Pediatric Workforce Shortage Persists.” Pediatric Workforce Persists, Children’s Hospital

Association, 19 Jan. 2018. Accessed 6 March 2018.

Eichner, Jerrold M. “Patient and Family-Centered Care and the Physicians Role.” Patient and

Family-Centered Care and the Physicians Role, Feb. 2012. Accessed 5 March 2018.

Moskowitz, William B. “Shortage of Pediatric Specialists.” Shortage of Pediatric Specialists,

Rising Number of Chronically Ill Kids Prompts AAP Call to Revamp Training Funds, 28

Mar. 2016, www.aap.org/en-us/about-the-aap/aap-press-room/pages/Shortage-of-

Pediatric-Specialists-Rising-number-of-Chronically-Ill-Kids-Prompts-AAP-Call-to-

Revamp-Training-Funds.aspx. Accessed 21 April 2018.

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