Why do doctors and patients clash?
It is simple:
we know, they don’t!
One problem is the hierarchy of knowledge that hinders the communication.
What do we know?
We know facts about the body.
This insight makes us almost as mighty as magicians in the view of many people.
We are supposed to be able to control sickness and health.
We could grant or deny healing (just imagine that!). This knowledge provides us with tremendous power in the eyes of the patient.
The hierarchy of knowledge hinders the communication.
Anything else?
Not only that, but we also have a clear idea about what is going to happen during the consultation. Especially, the paediatric patient has often no clue about this.
We are conducting the interaction. We control the structure of it, and are in the lead and often very active.
How much time, in any consultation, is the child talking in contrast to how much we are talking?
Why does that hinder the communication?
The patient listens. Often they become passive, and in general, they are supposed to follow.
This difference in influence is present between the doctor and any adult patient. Furthermore, the difference is even more evident when the patient is a child. Therefore, it would be most natural for the child to act fearful towards the powerful stranger.
The hierarchy of knowledge hinders the communication.
Surprised by trust!
During the time of my professional practice, I am more and more surprised by the fact, how often the interaction between the doctor and the child is so fruitful. With all the odds stacked against us, I would expect it to deteriorate more frequently.
The hierarchy of knowledge hinders the plan
Another effect of this hierarchy is that the parents sense a lack of entitlement to ask questions. This seems to be the case, even if they would want further information. This is a huge obstacle for the patient in receiving the information they need.
They feel poorly informed and this as a consequence leads to poor “by-in” to treatment plans.
The plan is our plan, not theirs!
The hierarchy of knowledge hinders the communication.
In a nutshell:
Knowledge is power; therefore, the (paediatric) patients feel powerless for a reason.
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