The consultation needs to be conducted, and the doctor is the conductor!
Any consultation consists of the following typical elements:
- Gathering information by taking a structured history of the patient
- Physical examination
- Identification of the problem (making the diagnosis)
- Agree on a plan for further action
These steps are typically followed in the order from1 to 4.
This approach is necessary for the general practitioner, as they would not have any idea, why the child is brought to the surgery. As a medical specialist, I have the information provided by the GP to guide me into the consultation. Even before the parent and I start talking, I do have an idea, what the consultation is about.
In my case, as Ear-Nose-Throat-Surgeon, I typically swap step 2 (physical examination) and step 1 (gathering of information).
Why do I swap physical examination and gathering of information?
Children are mainly afraid of the examination. As I wrote on the front page of this blog, children are preoccupied with the question: “Will it hurt?”
The examination is the part that frightens them the most during the whole consultation. As soon as this bit is done, they can relax in my office!
How do I get started with the physical examination?
The interaction between me and the child has actually already started in the waiting area with the connection that was made there. For details about this essential step, please click here about the timing, the location, and the process.
First, I have laid the foundation of a good connection between myself as the strange doctor and my child-patient. Second, I have empowered the child to become an active partner in showing their ear, nose, and throat via my “ear-television” to their parents. They and I are “buddies” now, the parents are mere observers!
At this very moment, there is nothing more important for the child, then to see their ears! And that is naturally the next thing we will do!
What comes next?
After the child showed their ears, nose and throat with the help of my monitor to their parents, I then instruct them about the next steps of the consultation.
From the child’s perspective, the consultation is “done” after the examination. They naturally want to go “now”. But that is of course not possible. This is the moment, when I need to tell the child, that I now will start talking to their parents. And I openly admit that this is “boring” for any child.
For this, moment during the consultation, I have some toys available in my office. These toys are age-appropriate, engaging and don’t make any electric sounds!
The favourite with the majority of children is the famous Rubik’s Cube, followed by a Tangram-puzzle and, for younger children, coloured wooden blocks or simple wooden animal puzzle. These toys need to be sturdy, unbreakable, and easy cleanable. They would have to be wiped down with a disinfectant cloth between every use!
They need to provide a “task” that is interesting for the child, and optimally achievable in the time I need, to talk to the parents. This way, the child is catered for and not bored, and the risk of them becoming disruptive is minimized.
Turning towards the parents
The consultation has to be conducted, and the doctor is the conductor!
Now I turn to the parents, and open our conversation with a summary of the information, I have already from their GP or any other sources. Typically, a day before the clinic, I look this up during my preparation time. All the information I have gathered, I have already noted in the draft version of the consultation letter. This way I only need to do this background check once, and automatically I streamline my letter process as well.
What is the effect when I let the parents wait this long?
You might have noticed, that for the first half of the consultation I was orientated almost exclusively towards the child. Now I pivot mentally and physically to the parents.
By delaying the interaction with them like this, I allow them to observe me and to make up their mind about me. I also allow them some time, to just catch their breath. And last not least, by interacting with their child positively, I take away their fear: Will it work (e.g. will the doctor be able to examine my child)?
When I finally turn my attention towards them, they are“ the moment” with me. I don’t need to put any further effort into syncing with them.
What is the effect when I open the conversation with a summary?
As mentioned before, I open this part of the consultation with a summary of the available information.
The majority of parents appreciate this preparedness. They feel seen and taken serious.
Previously I noted one typical complaint of patients and parents, and it was: Why do I need to repeat myself every time I meet a doctor, don’t you share the information I gave you before?
On the other hand, my summary typically ends with the question: “Have I understood the information correct?” Or “Is there anything you would want to add to this summary?”
And then?
Before I explain my findings, I want to be certain, that I have not missed any aspect that is important to the parents. For this, I use the I-C-E approach: Ideas — Concerns — Expectation:
- I — Ideas: What have you noted?/ What do you think bothers your child?
- C — Concerns: What are you worried about?
- E -Expectation: What would you think needs to be done?
At the end of this phase, the parents and I should have a common understanding about the problem at hand and their expectation for this consultation.
The next step would be to bring them up to speed with my findings, my thought-process regarding the diagnosis and the further plan.
The consultation needs to be conducted, and the doctor is the conductor!
Identification of the problem / making and sharing the diagnosis
Medicine is complicated. To communicate complex content is tricky, as I have noted previously.
And the answer is: This is best done in small bites and optimally with illustrations! This concept is illustrated in detail in this blog-post.
I use a dedicated explanation sheet as shown above for this part of the consultation for the following reasons:
- It allows me to draw into this sheet the specific findings per patient.
- It helps me to phase the explanation to a speed, that the parent can digest.
- It helps the parent present to later explain my findings to any partner, who did not attend in person.
- I can provide the parents with my name, in the case that they later want to get back in contact with me.
- I can provide them with a contact telephone number.
- I can provide them with a treatment plan that consists of several steps or significant details.
We know that parents only recall 20% of the information provided. Providing individualized tangible material helps in this aspect of the communication.
Any time invested here is not a “waste of time” as someone might think. In contrast, as the recall rate of the information gets better, I stop wasting time, by providing information that would otherwise be forgotten.
Agree on a plan for further action
The consultation needs to be conducted, and the doctor is the conductor!
With all the effort, that was previously spent on levelling the playing field of communication, any decision towards a treatment plan is intrinsically a shared decision, without any explicit further steps. As I am the conductor, I am no longer a dictator. I have to empower the parents and also include the child on their level with this planning. It might be obvious, that I need to adjust my language accordingly.
Here, the explanation sheet takes another role: the written words are a confirmation of the agreed path forward.
In the end, the child leaves my office with a feeling of safety, fun, and even accomplishment. The parent leaves as partner of the plan, with material available for them to explain the route for spouses or partners.
In a nutshell:
The consultation needs to be conducted, and the doctor is the conductor!
Previous post Next post
Connect Respect Engage Extra tips Contact/About me
Communication lives on comments … fancy to share yours?