Everybody perceives the consultation differently!
Everybody perceives the consultation differently
- The doctor
- The parent
- And last not least, the child
These perceptions are completely disconnected.
And that’s the problem.
These thoughts generally remain unspoken. However, they also form the background noise for both the verbal and the non-verbal communication.
What are the key moments of the consultation?
The typical scenario of a consultation contains certain predictable moments:
- Preparing for the appointment (a)
- Arriving at the location (b)
- Time to wait before the encounter (c)
- Uncertainty about the problem (d – g)
- Time of explanation of the problem (h)
- Agreement about the treatment plan (j)
- Departure (k/l)
In the next post, I want to invite you, to listen in on thoughts that might be present in all the participants of the consultation.
The perception of the parent of the consultation
Let’s have a look at the train of thought of the parent first.
The graph in the illustration shows the time on the x-scale and the level of stress on the y-scale. A stress level of 5 would be average, while 0 would to be asleep and 10 would be close to freaking out.
The graph illustrates the parent’s inner train of thoughts and stress level during the consultation.
The letters a – n indicate specific moments during the encounter.
So now, let’s listen …
Before the consultation:
(a) “Do I have everything?
I must rush to get my child ready!
Are we on time?
Is the bus delayed again?
Where to park the car?
(b) Where do I need to go?
Where is the reception?
Do we need to wait long?
Can the doctor help us?
(c) Will my child behave?
It is so exhausting when my child is sick!
I hate waiting. Is there still time to go to the toilet now?
When is it our turn?”
During the consultation:
(d) “Are you listening?
Do you understand me?
(e) Why do I have to tell the story again?
Have you even read the file?
(f) What a bunch of questions, is this an exam?
(g) I hope my child allows the doctor to examine her/him!
My child is restless, maybe a threat will do the trick.
(h) What is the doctor saying?
Where do they learn to speak like this?
(i) I need to listen to the doctor.
I don’t understand a word of these medical terms.
(j) Let’s try to calm my child down for a moment by bribing her/him.
(k) OK, here we go, “goodbye”.
Let’s teach my child some politeness, “say ‘thank you’ to the doctor”.
“Come on, say “thank you doctor.”
After the consultation:
(m) “Finally I made it home and here is the prescription.
(n) I hope the treatment works.
And now my partner asks: “What did the doctor say?”
How am I supposed to know?”
The perception of the child of the consultation
Everybody perceives the consultation differently
Let’s switch our attention to the train of thought of the child.
The child’s inner train of thoughts and stress level during the consultation might have the following text …
Before the consultation:
(a) “Mummy and I are going to the doctor.
(b) Mummy is nervous, so it must be bad!
(c) The waiting area is not too bad; I can play here!
The doctor calls me and I am scared.
(d) I remember the last time with the doctor:
They are bastards and liars.
Initially, they will act friendly, but out of the blue that doctor put a NEEDLE IN ME!!!
So go away, leave me alone and do not dare to touch me.
During the consultation:
(e) Now I need to sit next to mummy, and the adults are talking on and on.
(f) That is so boring, why can I not just play in the waiting are while you are talking?
(g) What do we get now?
Someone is holding me and regardless how hard I try, I can’t get out of here.
(h) Even though I am fighting for my life. Is there anybody out there to rescue me from this?
The doctor pokes me and looks at me and asks me to open my mouth, but why should I?
(i) Why do we have to stay here after the examination is done?
All the talking of adults doesn’t make any sense to me.
(j) I want to just leave. I shall run away now.
(k) Now mummy gives me a treat, that is at least something.
(l) Now I am busy munching away the sweet.
It is really time to go NOW.”
After the consultation:
(m) “Finally we are back home.
(n) Here I really can play. I never want to go there again!”
The perception of the doctor during the consultation
Everybody perceives the consultation differently
Therefore, last, not least, let’s have a look at the train of thought of the doctor.
The doctor’s inner train of thoughts and stress level during the consultation might sound like this:
Before the consultation:
(a) Another day in the outpatient-department, that is another 15 patients in 3 hours.
Time is money.
I hope they are not talking too much.
(b) Calling the next one in …
Why do they always have to use the toilet just as I try to call them in?
I have a schedule to adhere to!
(c) I need to get this is over with because I already have something else on my mind.
During the consultation:
(d) Wow, she starts talking before she even sits down.
May I open the medical notes first, please?
Let’s dig deeper into the mother’s story.
(e) I am surprised how little she knows about her child’s symptoms.
(f) How can she expect that I figure out what is wrong here if she provides almost no information?
(g) If only she could hold her child tight.
I really need to have a look here.
How does she think I could give a proper opinion if I can’t even touch the child?
(h) Let’s give her a summary of my findings.
(i) Now I will explain a little of the background of the situation.
(j) And now, we need to turn to discuss the next treatment steps.
(k) Isn’t it possible for the child to be quiet for just one moment?
(l) Why are children so poorly mannered nowadays?”
After the consultation:
(m) Get out of my office.
There are fourteen more patients waiting.
(n) Honestly, I don’t need the child to thank me, just to give way for the next in line.
If we superpose those dynamics, there are some lessons to learn.
Lesson of the combined view
Everybody perceives the consultation differently.
It is easy to see, that in the typical appointment these inner storylines are completely out of sync.
The combined view on the inner train of thoughts and stress level during the consultation demonstrates:
- At any given moment, the inner story of the participants drifts in alternating directions.
- For this reason, everyone experiences the encounter differently.
- There is hardly any connection between the parent and the doctor, let alone between the child and the health care provider.
Although we try to cover up for our negative thoughts and do our best to keep up appearances, the rise in tension is noticeable non-verbally.
This will have an impact on the quality of the encounter in the surgery.
This background noise will determine, whether the encounter between the doctor and the paediatric patient is:
Either traumatic or fun
Either confronting or cooperative
If we want to connect with a paediatric patient and the parent, we need to be open to their views, their experience of a moment in life that is routine for us, but extraordinary for them.
As always, the story doesn’t start when they enter our office. As I have mentioned before, they come with mindsets, with their explanation about the situation and with their agenda for the encounter.
In a nutshell:
Every contributor to the appointment experiences that very differently, the inner storylines are typically completely disconnected.
Ignoring this, leads to ineffective communication.
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