Paediatric Handbook

Kate Harding, Daniel S. Mason, Daryl Efron, Kate Harding, Daniel S. Mason, Daryl Efron

• Publisher: Wiley-Blackwell
• Year: 2020
• Print ISBN: 9781119647072
• eBook ISBN: 9781119647386
• Edition: 10
• Topic: Medicine
• Subtopic: Pediatric Medicine

The Royal Children's Hospital Melbourne Paediatric Handbook isa trustedguideto managing common and seriouschildhoodillnessesand disorders.This bestselling resource provides students and practitioners acrossmedical, nursing, and allied healthfields with authoritative and up-to-date information on a comprehensive range ofpaediatrictopics, enabling readers to maketheappropriate decisions at the point of care.

Now in its tenth edition, theHandbookfeaturesclear illustrationsandevidence-baseddiagnostic and management algorithmsthroughout, coveringresuscitation andmedicalemergencies, prescribing andtherapeutics, medicine, surgery, procedures, and much more.

• Contains accessible summaries of common and seriouspaediatricillnesses and disorders
• Aligns with latest clinical practice guidelines
• Features numerous full-colourphotos, illustrations, diagrams, andclinical images
• Provides practical guidance on professional ethics and communication in paediatric consultations
• Includes updated information on refugeehealthandtrans and gender diverse health

Paediatric Handbook is an invaluable referenceformedical practitioners, nurses andalliedhealth professionals, as well asstudents and trainees.

CHAPTER 1
Communication in the paediatric consultation

Mike Forrester
Daryl Efron

---

Key Points

• Elicit the family’s main concerns, ideas about the problem, and how they think you can help.
• Involve children in the consultation according to their developmental level and interest.
• Learn to use a range of structural models and communication ‘microskills’ to enhance consultation efficiency and achieve shared decision making.
• Be alert to verbal and non‐verbal cues and use a range of techniques to respond to emotion.
• Conscious communication skill practice will improve the child and family’s experience, increase adherence, decrease errors, health care costs and litigation and also improve clinician well‐being or ‘joy in work.’

---

Effective communication is fundamental to effective clinical medicine. Flexibly employing a range of communication skills is key to eliciting accurate diagnostic information and understanding the child/family context, which is necessary for shared decision making. Yet clinical communication skills are not innate, nor do they necessarily improve with clinical experience alone. They require learning and conscious practice. Good communication skills improve patient experience, increase adherence, decrease errors, decrease health care costs and litigation and also improve clinician well‐being or ‘joy in work’.

The triadic consultation of paediatrics (doctor–parent–child) poses extra challenges. The child and all carers present need to be encouraged to engage and share their agendas. This requires flexibility in approach, allowing for differing educational, cultural, and religious backgrounds, and levels of social connectedness and advantage. The possibility of trauma or adverse childhood experiences may need to be considered as they will influence the best approach to communication and building trust (See Chapter 14, Behaviour and mental health). Connection with the child and family will be enhanced if the clinician embodies empathy, patience, a non‐judgmental approach and conveys curiosity and enthusiasm.

It is professionally satisfying to complete the consultation knowing that clinician and family have both met their agendas in the available time and also enjoyed a human connection. However, all clinicians will have moments when they feel there is a disconnect with the child and the family one is trying to help. Sometimes it can be difficult to pinpoint why the disconnect has occurred. Breaking down the elements of the consultation structure can help (Figure 1.1).

Clinicians employ a range of communication skills to build the relationship, allow a consultation to flow or to recognise the need for repair. These ‘Microskills’ are the elements of effective communication. They include techniques such as asking open questions, use of silence, responding to verbal and non‐verbal cues, responding to emotion, chunking and checking, microsummaries, and signposting (Table 1.1). This chapter introduces the reader to some of these core communication skills.

Figure 1.1 The Calgary Cambridge process.

Sources: Skills for Communicating with Patients. 3rd Ed. Jonathan Silverman, Suzanne Kurtz, Juliet Draper. CRC Press, Published September 2013 and Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary–Cambridge guides. Acad Med. 2003; 78:802–9. Reprinted with permission.

Table 1.1 Micro‐skills to enhance communication effectiveness.

Micro‐skills to enhance communication effectiveness.

Explore shared agenda ‘What do we want to achieve today?’

Open to closed cone questions (start open, then move to more directive questions) and screening questions, ‘is there anything else that’s troubling you’

Listen actively, avoid interrupting

Encourage more information ‘Tell me more’, use of silence

Facilitate by encouragement, paraphrasing, interpretation

Identify and explore cues to underlying concerns, verbal and non‐verbal e.g. eye contact, facial expressions, posture, vocal rate/volume/intonation

Use explicit empathy e.g. ‘I’m sorry to hear that’, ‘That sounds really tough’, 'I can't imagine how this might feel for you, but I wonder…’

Demonstrate confidence with your assessment/differentials/plan (e.g. with regards to what you find reassuring and why)

Explain rationale for suggested investigations and management plan

Avoid jargon: Use concise and easily understood language

Progress using Signposting: explicitly sharing the structure/plan e.g. ‘would it be ok if we first talked about… and then…’ or ‘There are three important things I'd like to discuss, first…’

Use visual methods for conveying information where useful

Chunk and check: Provide information in assimilable chunks, check...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• List of Contributors
• Acknowledgements
• Foreword
• RCH Handbook List
• Preface
• CHAPTER 1: Communication in the paediatric consultation
• CHAPTER 2: Ethics
• CHAPTER 3: Resuscitation and medical emergencies
• CHAPTER 4: Poisoning and envenomation
• CHAPTER 5: Procedures
• CHAPTER 6: Pain management
• CHAPTER 7: Fluids and electrolytes
• CHAPTER 8: Prescribing and therapeutics
• CHAPTER 9: Immunisation
• CHAPTER 10: Nutrition
• CHAPTER 11: Growth
• CHAPTER 12: Adolescent medicine
• CHAPTER 13: Allergy
• CHAPTER 14: Behaviour and mental health
• CHAPTER 15: Cardiology
• CHAPTER 16: Clinical genetics
• CHAPTER 17: Dentistry
• CHAPTER 18: Dermatology
• CHAPTER 19: Endocrinology
• CHAPTER 20: Forensic medicine
• CHAPTER 21: Gastroenterology
• CHAPTER 22: Gynaecology
• CHAPTER 23: Haematology
• CHAPTER 24: Immunology
• CHAPTER 25:Infectious diseases
• CHAPTER 26: Metabolic medicine
• CHAPTER 27: Neonatal medicine
• CHAPTER 28: Neurodevelopment and disability
• CHAPTER 29: Neurology
• CHAPTER 30: Oncology
• CHAPTER 31: Ophthalmology
• CHAPTER 32: Orthopaedics
• CHAPTER 33: Otolaryngology
• CHAPTER 34: Palliative care
• CHAPTER 35: Refugee health
• CHAPTER 36: Rehabilitation medicine
• CHAPTER 37: Renal medicine
• CHAPTER 38: Respiratory medicine
• CHAPTER 39: Rheumatology
• CHAPTER 40: Sleep medicine
• CHAPTER 41: Surgery
• CHAPTER 42: Trans and gender diverse health
• APPENDIX: Antimicrobial guidelines
• Index
• End User License Agreement