Dealing with parental concerns: A study of GPs' practice

Abstract

Objective: To investigate patterns of GPs' exploration and termination of dialogues about parental concerns in preventive child health assessments. Methods: Interactional microanalysis of video recordings of 32 preventive child health assessments using conversation analysis. Results: The GPs asked parents about concerns, but most concerns disclosed by parents were still left unexplored at the end of the consultation. Termination of dialogues about concerns could be achieved effectively by GPs through letting the biomedical agenda dominate or addressing the child directly. The parents generally cooperated with the various approaches to handling concerns. Conclusion: GPs displayed initial attentiveness towards emotional concerns but did not always follow through with subsequent exploration; many concerns raised were left unexplored. However, the same GP could employ both non-exploratory and exploratory practice within individual consultations. Practice implications: Preventive child heath assessments offer an opportunity for parents to raise concerns about their children's development. Improved understanding of the conversational mechanisms through which concerns are examined or sidelined could allow clinicians to maximise the effectiveness of their preventive consultations.

Increasing the psychosocial focus in child developmental assessments: a qualitative study

“…Clinicians’ ability to listen and communicate is an important element in patient experience [ 44 , 47 ], and trustful clinician-patient relationships along with positive responsiveness should enable parents to bring up psychosocial problems in the future. It has previously been identified that parental concerns mentioned during the developmental assessments were not subsequently explored and were often terminated by the clinician [ 48 ]. Moreover, psychosocial issues were repeatedly de-emphasised in favour of the physical examination [ 48 ].…”

“…It has previously been identified that parental concerns mentioned during the developmental assessments were not subsequently explored and were often terminated by the clinician [ 48 ]. Moreover, psychosocial issues were repeatedly de-emphasised in favour of the physical examination [ 48 ]. This demonstrates that uncovering psychosocial aspects is not equivalent to handling psychosocial concerns properly.…”

“…Doctors, however, do not know their patients' and families' vulnerabilities as well as they think [49,50] and patients often do not bring personal matters up by themselves [51][52][53]. There exists a parental uncertainty about the purpose of the developmental assessments [48] which can also inhibit parents from bringing up psychosocial issues. Additionally, parental attitude has a great impact on the extent to which psychosocial aspects are explored [25] in line with our findings that clinicians find psychosocial aspects hard to address if parents are very physically focused.…”

Prognosis and bio-psycho-social prognostic factors in children and adolescents with musculoskeletal pain consulting general practice

“…This is critical, since children exposed to environmental stressors or early adverse life events might have a higher risk of cognitive, emotional, and health problems 31 . These concerns are often not addressed during general practice consultations due to time limitation or reluctancy 64 . This leads to discrepancy between concern and elaboration 64 .…”

“…These concerns are often not addressed during general practice consultations due to time limitation or reluctancy 64 . This leads to discrepancy between concern and elaboration 64 . Identifying and addressing negative pain beliefs becomes important in treating adolescents with MSK pain in general practice 65 to encourage acceptance and transition into self-management.…”