Importanța comunicării medic-părinte în managementul terapeutic al pacientului pediatric

Introduction

In pediatrics, an effective physician-parent relationship is essential for the child’s health, therapeutic management, and both primary and secondary prevention^(1,2). Helen Epstein aptly observed: “Doing everything right is infinitely harder when patients don’t know the right words to describe what they feel”, thus illustrating the complexity of pediatric care, where physicians interact with patients at various stages of development, from newborns to adolescents. These developmental stages require differentiated approaches tailored to the intellectual and psycho-emotional maturity of the patient^(3,4). 

The aim of this study is to highlight the importance of communication between physicians and parents or legal guardians of children aged 0 to 3 years old – a critical period marked by rapid development, higher morbidity and mortality risks, and the child’s inability to verbally express. During this stage, the physician and parent must work as a team to ensure the child’s proper growth and development.

Materials and method

Our objective was to evaluate parents’ perceptions of physician-parent communication and the extent to which it influences the therapeutic management, cooperation, adherence to treatment plans, and the decision to return to the same healthcare provider. We conducted a prospective and observational study based on an online questionnaire addressed to parents or legal guardians of children aged 0 to 3 years old. The questionnaires were distributed and completed online with the help of specialized platforms (such as Google Forms), in the period from 20 March 2023 to 1 June 2023, and the respondents came from the counties of Iași, Mureș and Bistrița-Năsăud. The questionnaire analyzed 12 items, targeting the purpose of the study. This age group was selected due to its developmental characteristics, high morbidity and mortality risk, and the child’s inability to participate verbally in medical history taking. We therefore consider this age group the most representative in terms of the need for effective physician-parent communication. Inclusion criteria: children aged 0 to 3 years old and their parents/legal guardians who were hospitalized with them in a public healthcare facility. Exclusion criteria: parents of children older than 3 years old, caregivers not hospitalized in public institutions, and incomplete questionnaires. Out of 90 respondents, two incomplete questionnaires were excluded. A total of 88 questionnaires were included in the final analysis.

Results

The study participants identified several physician behaviors that limited their willingness to communicate: a distant attitude, lack of dialogue, indifference, failure to acknowledge maternal distress related to their child’s health, and a hurried demeanor.

These factors contribute to an ineffective physician-parent relationship, characterized by a lack of trust and empathy, ultimately resulting in suboptimal therapeutic management. We also observed a strong parental desire to collaborate with the physician by providing relevant information during both anamnesis and hospitalization.

The majority of respondents (95.4%) were mothers. Therefore, we emphasize the importance of early recognition of prenatal and postnatal depression by medical professionals interacting with new mothers, as timely intervention can prevent negative consequences for the child’s development. Some parents also highlighted the inclusion of preventive measures – both primary and secondary – communicated verbally by the physician, as part of effective medical care.

Prevention in pediatrics, particularly in the 0-3 years old age group, plays a key role in shaping future health outcomes. For example, obesity, one of the most widespread global health issues, can be prevented through appropriate early interventions, which in turn rely on effective communication with parents.

Such communication helps parents understand the dangers of inadequate breastfeeding practices and improper complementary feeding. Respondents considered disease recurrence prevention a normal part of care and expressed their desire to receive clear and detailed guidance from healthcare providers regarding lifestyle management for both the child and the family, especially in cases of conditions with high recurrence risk^(5-7).

Given the global concern of antibiotic resistance, we asked parents whether they would accept symptomatic treatment even if they perceived their child’s condition as “serious”. An overwhelming 95.4% stated they would accept it, provided that the physician offered a clear explanation based on clinical examination and paraclinical investigations demonstrating a non-bacterial etiology (Figure 1).

We view this as a highly encouraging result, supporting the need for further studies on this topic and the implementation of routine communication training for healthcare professionals. Parents emphasized the importance of being listened to and not feeling as though healthcare professionals lacked time for their case.

A significant percentage (74.7%) of the respondents associate effective communication with good professional training (Figure 2).

When asked what aspects of a physician’s attitude discouraged them from sharing detailed medical history, the most frequently cited were: lack of explanations, brief or dismissive answers, distant behavior, insufficient clinical examination, and lack of attentive listening (Figure 3). These behaviors undermined trust in the medical team and reduced willingness to disclose valuable information.

Empathy, active listening, calmness, a positive demeanor, and genuine interest in the child and parent were described by respondents as key elements for establishing a successful physician-parent relationship. Ultimately, all participants agreed that effective communication with the physician is essential.

Discussion

Effective physician-patient communication is essential for successful therapeutic management. Numerous studies have documented the multifaceted benefits of good communication^(2,8,9). For instance, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, introduced 17 years ago, showed that physician communication can account for approximately 25% of a hospital’s overall score^(10,11).

In a study involving over 6000 parents, a significant correlation was found between the perceived quality of care and physician communication – an observation echoed in our study, where 74.7% of participants agreed that the physician’s communication style directly impacts the perceived quality of medical care⁽¹²⁾.

Nonverbal communication – which constitutes up to 80% of overall communication – must be given renewed attention. Studies show higher patient satisfaction scores when physicians use effective nonverbal communication (Figure 4)^(13-15). These findings align with those from our study, in which parents expressed the need to feel the physician’s active presence, unhurried approach, and genuine interest in the case. Examples include avoiding the use of phones during consultations, maintaining appropriate physical proximity, showing attentiveness during anamnesis, and using facial expressions such as smiling. These nonverbal cues encourage parents to actively contribute to the therapeutic process, whereas their absence may lead to defensive behaviors, insufficient information disclosure and to nonadherence to medical recommendations, potentially resulting in complications or hospital readmission^(1,13,14,16).

Mothers are the primary caregivers for children aged 0-3 years old. Studies have linked maternal depression to adverse child development outcomes. One study based on data from 3119 children (including Hispanic, White, African American and other ethnic backgrounds) from the Family and Child Experiences Survey (2009) found early behavioral problems in children whose mothers experienced postpartum depression. These problems were particularly prevalent among African American and Hispanic populations^(17-19). 

Consequently, we believe that both family physicians and pediatricians should be well-trained in recognizing postpartum depression to provide timely intervention and specialized referrals^(18,19,20).

Patient satisfaction is strongly tied to healthcare provider communication skills. For academic medical centers, communication training has become a key priority. A study based on the Calgary-Cambridge guide showed that over 90% of students who received structured communication training demonstrated significantly improved communication abilities^(15,21,22).

The HCAHPS survey also revealed that effective communication can lead to a 1.5-2% increase in hospital revenue. In our study, participants also emphasized communication as a cornerstone of effective therapeutic management⁽¹⁶⁾.

A study similar to ours, involving parents and caregivers of pediatric patients, concluded that implementing effective communication practices is one of the most impactful strategies a hospital can adopt to increase patient^(12,23,24).

Physicians involved in pediatric care should explain, encourage and assist mothers in exclusively breastfeeding their infants up to 6 months of age, and ideally continue breastfeeding (alongside proper complementary feeding) until at least 2 years of age, as recommended by WHO^(5,25,26). Breast milk is the most appropriate and bene­ficial form of nourishment for newborns and infants, offering advantages not only for individual families but for society as a whole. Breast milk is the most appropriate and beneficial form of nourishment for newborns and infants, offering advantages not only for individual families but for society as a whole^(26,27).

Given the geographic and climatic context of our country, optimal levels of vitamin D for proper development in children aged 0-3 years old cannot be achieved solely through sun exposure^(28,29). Therefore, rickets prevention – an essential pediatric goal – must be supported through physician-parent communication, including guidance on oral vitamin D supplementation^(30,31).

Failure to actively listen to parents can contribute to diagnostic errors. In the USA, approximately 12 million children are misdiagnosed annually, and 32% of malpractice cases are related to diagnostic errors. Thus, taking the time to listen brings significant benefits for the physician-parent-child triad and the healthcare system⁽³²⁾.

Establishing a therapeutic relationship with the patient has always been and remains the foundation of effective medical care. In today’s world, where empathy and humanity are increasingly needed, the medical profession plays a crucial role. Medical schools have recognized that while medicine has advanced, these advances may come at the cost of human connection^(11,33,34). Therefore, empathy must be taught and nurtured from the earliest stages of medical education. Studies show that empathy begins to decline during medical school, underscoring the need for ongoing “schools of empathy” and continuous medical education throughout a physician’s career^(35,36).

Conclusions

We believe that effective communication with parents or caregivers of children aged 0-3 years old is a fundamental pillar in preventing various pathologies associated with this age group.

Most of the questionnaires were completed by mothers, which is why it is important to pay attention to their health, especially in the immediate postpartum period. According to the analysis of the questionnaires, parents want: a doctor who is empathetic, calm, open to communication, and for communication to be present both during the anamnesis and later during the hospitalization, through which they can obtain information about the child’s health status, medication, primary and secondary prevention. Most respondents say that, based on effective communication, they would follow the doctor’s recommendations both during hospitalization and afterward. The insistence on administering antibiotics (especially at home and without medical advice) would decrease if parents received medical education so that they could understand the purpose and necessity of antibiotic therapy. The level of communication is associated with the professional training level of the doctor, and the decision to return to the doctor is influenced by how they communicate.

The limitations of the study are represented by the small number of respondents analyzed and the fact that the responses were provided at a distance from the moment they were admitted with the child. In conclusion, future larger-scale studies exploring parental perspectives on the physician-parent relationship, as well as the impact of communication training for healthcare professionals, are of critical importance. Such efforts promise broad benefits across all levels: for children, parents, medical professionals and healthcare institutions.  

Corresponding author: Heidrun Adumitrăchioaiei E-mail: heidrun.adumitrăchioaiei@umfst.ro

Conflict of interest: none declared.

Financial support: none declared.

This work is permanently accessible online free of charge and published under the CC-BY licence.