It is scary to enter a dungeon!
By now, it should be clear that the transition into the examination room is a delicate moment for the consultation.
If it is rushed, the child will likely refuse to cooperate inside “my place”.
This transition needs to be prepared, and the trust needs to be gained first.
Only after the child and the parent have decided to trust me as their doctor, we can move together without increased anxiety on the side of the child and their parents.
What background have we seen before?
At the beginning of this blog, I have explained how new situations either trigger fear or curiosity.
This post illustrates the application of that background.
Tipping the balance towards confrontation
Confrontational behaviour from the child will be triggered by everything that increases fear in the patient.
Depending on the previous experience of the child, there might be different levels of challenges. We would need to identify, how to help the child, to feel safe even in this potentially “hostile” environment. It is one task of the doctor to help the child through any fear.
More confrontation
How would you respond when:
- You are dragged from the toys of the waiting area
- You are placed into a space with a lot of unfamiliar and potentially dangerous objects visible
- When this is followed by a stranger who rushes up to you
- And this stranger overpowers you with the sheer size of an adult
In this setting, the recipe for disaster is almost complete.
Can it get worse?
The only thing missing for a melt down, would be
- a parent with a high-stress level
- who immediately claims the space for themselves
- when then unburdens themselves of the story of their difficult dealing with their child’s symptoms.
When the child observes a confrontation between the healthcare provider and their parent, it will choose not to cooperate with the stranger.
Tipping the balance towards cooperation
It is less scary to enter a dungeon, if you see that as an adventure!
The trick is in the latter part of that phrase!
Both dangers and adventures contain uncertainty.
Both are tense experiences. But while we avoid the first, we choose to engage in the latter!
To establish a sense of cooperation:
- It is advisable that the child walks by themselves into the surgery, rather than being carried there. Any distance that we pick to go by ourselves, does not cause fear, any path that we are dragged along, will cause more resistance.
- Therefore, I use curiosity to gain their attention.
- I promise “ear-television” as “bait” to invite the child into the examination room and even onto the examination chair.
- There needs to be a positive reason for the child, why this move is in their interests (immediate, short term, not the long-term health goal). I suggested this also in the post about “Just let them see”.
The child has decided to trust me within the first 7 seconds and now decides to be interested in the adventure that I seem to offer.
Arriving inside the examination room
Inside the examination room, everything is arranged, with only the examination chair and the monitor behind it.
The goal is that nothing else is distracting the child (no visible toys) on the way to the examination chair. Now, when the trust of the child has already been gained in the waiting area, the child will follow me out of curiosity about the ear television.
Setting up the consultation
Contrary to the typical routine, in general, I perform the examination first.
My reason for this is that this part of the consultation is most scary for the child.
They want to get over with this aspect due to curiosity and partially due to fear. Also, with this reorganisation, the active part of the child comes first after entering the office, and therefore I can maintain the level of contact initiated in the waiting area.
Furthermore, in my case, the medical history has little influence on the way that the ENT-examination takes place.
In a nutshell:
It is less scary to enter a dungeon, if you see that as an adventure!
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