Connect with the child (and parent)
We need connection for effective communication.
If we fail to connect with the child and their parent, nothing of what we say will be communicated effectively.
In the following posts, I highlight obstacles for basic communication in general. They also play a role in hindering reliable connections in the clinical setting with the child and their parents.
You can find out more by choosing the following blog posts.
- Concept of reality
Screenshot There are always different ways to interpret given facts. They result in different concepts of reality.
During most of the time, we are living in a “personal” world shaped by our experiences, assumptions, and prejudices.
- Flipping perspectives
Flipping the image works Flipping the perspective works.
Stepping in our (paediatric) patient’s shoes is necessary.
It is possible to step out of our mental routine and to slip into the shoes of our (paediatric) patients, to aim to see the world with their eyes.
- Patients-medical belief system
Your patient “knows” why they are sick … Patients have their medical belief systems.
This medical belief system represents the patient’s idea about the cause of the disease.
The patient and parents often have also an idea, how the disease might be treated.
Why do they do that?
- Fear and curiosity
In new situations, fear is 
In balance with curiosity! New situations trigger either fear or curiosity.
Whenever we find ourselves in a new setting, our emotions are pondering between fear (and associated emotions) and curiosity (and associated emotions).
- Purpose of fear
Fear aims to protect The purpose of fear is to keep us safe.
We observe, keep our distance, withdraw and refuse to interact for the sake of safety.
Fear is an essential emotion to secure survival because it ensures adaptive reactions in hostile situations.
- Purpose of curiosity
Curiosity opens possibilities! Curiosity is needed to explore new situations.
New situations trigger curiosity
Fear of a new situation and curiosity about the new situation are in balance.
Fear sees everything as a threat, curiosity sees everything as adventure.
Same thing, opposite emotional effects.
- Just Be Odd
Being odd has a curious effect Just be odd — to push the brain towards curiosity
What happens to our fear, when we laugh?
Our fear disintegrates. For that reason, we cannot be afraid, when we wonder about what is going on.
We try hard to make sense of the world, and funny things do not happen in scary places.
Read more - First impressions count
It takes as long to burst a bubble than to make a first impression First impressions count massively
It takes 100 milliseconds to form a first opinion about a stranger’s attractiveness, likeability, trustworthiness, competence, and aggressiveness. We judge others by appearance within the first 100ms! This is merely as long as the blink of an eye, but this is all the time you have!
During the next 7–10 seconds, we finalize our judgment whether the person in front of us is either a potential friend or an enemy.
This “first impression” however is not the very first emotional response to the appointment.
- The role of timing
Emotions like fear and curiosity influence how we experience time Our emotions influence how we experience time!
Time is very flexible in our perception.
When we are in a positive mood and actively engaged, then time flies. Otherwise, we all know the situation when time crawls.
Obviously, enough is that anything, that we consider as negative, takes too long. In another case, positive experiences are over in a blink of the eye.
- Space matters
Distance is important in non-verbal communication Distance is important in non-verbal communication. Depending on the distance to another person, we instinctively react with a hard-wired set of responses.
Here is an illustration:
Cheetah versus Antelope
During a visit to Botswana, I came to see a cheetah lying on the slope of a termite mound, completely relaxed. There was nothing around, so the animal saved as much of its energy as possible. This lasted until a group of antelopes passed by in some distance.
- Height matters
Being looked down upon triggers fear Being looked down upon triggers fear in us.
Why?
Because we feel overwhelmed, exposed and threatened by the person looking down upon us.
In this way, height plays a significant subconscious role in the interaction with the other person.
I am an average size person (at least in Germany) and one effect of my size is that I am far taller than most of my paediatric patients. So, when I walk up to them, they must look up to me when I stand.
- The power of eye contact
The power of eye-contact: to see is to connect The power of eye-contact: Everybody needs to be seen. We are creatures of relationships, and we need interaction. If COVID-19 taught us anything, then that: Everybody needs to be seen.
Too little or too much eye-contact?
Although everybody must be seen, there is also a balance between too little eye contact (“the doctor didn’t even look at me, while doing the examination”) and too much (“I felt stripped naked under the gaze”).
- What is your IQ?
Intelligence differs between doctors and patients Intelligence differs between doctors and patients
Where are you on the IQ scale?
In the general society, an IQ of 100 would equal an average IQ.
Studies strongly suggested that the average IQ of doctors is 127.
Just to pass medical school demands a level of intelligence that is above the average.
On the other hand, we stick to our peers for self-assessment. As doctors, we live in an environment full of high achievers. So far, so obvious. This environment lets us think that we are “average” just like many of our patients.
- Communication is everything
Communication is everything — Everything is communication Communication is everything.
Communication is one of the most fundamental tasks of doctors.
We are constantly relying on sending and receiving information to provide our service.
Who are we communicating with?
Our communication partners are:
- Paediatric patients and their parents
- Our supportive partners (nurses, PA, dieticians, …)
- Our colleagues in teams for multidisciplinary approaches
- The wider hospital work force (secretaries, porters, cleaners, …)
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We often experience an interrupted communication with our patients.
As I wrote in my previous post, communication is judged by the recipient, not by the sender. So let’s have a look at how we are doing.
Lucky for us, the aspect of communication between doctors and patients has been studied extensively. Unfortunately, the results make for a grim reading:-
- Between 50 and 80% of the information is immediately forgotten.
- The greater the amount is of information presented, the lower is the proportion that is correctly recalled.
- Almost half of the information that is remembered, is incorrect.
- Between 30 — 50% of the patients are considered non-compliant with the doctor’s orders.
- For longer-term treatments, the rate of adherence to the treatment plan can be as low as 30%.
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- The process of communication
In real life, information gets lost during communication The ideal vs the real world of communication:
It would be so nice if the transmission of information could always happen without any loss or alteration of the content during the process of transfer.
Ideal of communication: 100% of information is transferred. - The role of “change” in medical communication
Changes are often needed in medical circumstances Change is regularly needed in medical circumstances.
For example, as soon as someone comes to the doctor, it becomes apparent, that matters cannot stay the same.The different aspects of change …
They come with a problem that they want to have addressed.
- The backdrop of change: Persuasive communication
Persuasion changes the course Persuasive communication initiates change.
What is persuasive communication?
According to Wikipedia, Persuasion is defined as:
“Persuasion or persuasion arts is an umbrella term for influence.
Persuasion intends to influence a person’s beliefs, attitudes, intentions, motivations, or behaviour. “The American Psychology Association gives the following explanation:
Persuasive communication is:
Information that is intended to change or bolster a person’s attitude or course of action and is presented in written, audio, visual, or audiovisual form.In essence: All form of communication that has an aim other than to just entertain has characteristics of persuasion. - The backdrop of change: Cognitive dissonance
Liars are bad people, I just lied … One step towards change is through cognitive dissonance.
Nobody likes to hear that they are mistaken. But, if we want to inform our patients and their parents to make better choices, we need to challenge wrong ideas nevertheless.
How do you feel when being contradicted?
What do you feel when someone points out that made an error? Within the first millisecond, you feel attacked or threatened. In this case, the instinctive response will be to defend yourselves. You raise your guard and fend off any input that challenges the way you might think about the world.
This basic response appears to be hardwired in our minds and seems to be unrelated to age. - Inner storylines of the (paediatric) patient
Complex topics confused or ordered by mental shortcuts Typical inner storylines of the (paediatric) patients are:
- Disease is the result of guilt:
- either I am punished for my mistake.
- or someone else is to blame for my suffering.
- The most visible coincidence must be the cause of the disease.
- Nobody can help me.
- I must fight to get what I deserve.
- The doctor is not really interested in my wellbeing but merely in their earnings.
Read more
- Disease is the result of guilt:
- How to deal with complexity
Reducing complexity improves communication There is a need to reduce the complexity of our conversation.
Medical information is complicated, and therefore we need to reduce the complexity of our conversation.
The body is a composition of systems that are interdependent and interactive.
Any change in one aspect of the body can have far-reaching and (for the patient) often unexpected effects in other areas.
- How to deal with uncertainty
Different expectations of uncertainty Nobody likes uncertainty, but we have to live through it together.
We want to have control of the world, or at least predictability.
We crave certainty and this is evident in any conversation about disease, treatment, and health issues.Ambiguity terrifies us.
Different expectations
Patients and doctors come with different expectations to this topic.
- The curse of knowledge
When you know, you don’t know what others do not know The curse of knowledge is, that you don’t know what they don’t know.
When you know something, it is difficult to see the world without that knowledge.
In the first post of this blog, I highlighted the different ways we all see the world.
We use “perception filters” to make sense in a complicated world and to orientate ourselves quickly.There is also another aspect to this filtering that I have not yet highlighted: the curse of knowledge.
- The different needs regarding time: Doctor’s time requirements, patient’s time requirements
(coming soon!)
