Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.
INTRODUCTION/OVERVIEWHealth care communication is a critical, but generally neglected, component of pediatric and pediatric subspecialty practice and training and is a skill that can and must be taught. [1][2][3][4][5][6][7][8][9][10][11][12][13] The practicing clinician's ability to communicate openly and with compassion is essential for effective and efficient routine health care; this ability becomes a vital lifeline for parents and children confronted with lifealtering and sometimes life-ending conditions. [13][14][15][16] The purpose of this report is to provide research-based and practical guidance to enable effective communication with pediatric patients and their families in a number of common settings and situations. Although child abuse, sexuality, divorce, and many other situations are not individually addressed, the principles and approaches discussed apply equally to these situations.Communication is the most common "procedure" in medicine. Health care communication is different from normal social discourse, because intimate and very private issues are often discussed. These include hopes and fears, developmental concerns, sexuality, and mental health disorders. Painful issues, such as abuse, school failure, drug use, and terminal illness, are also discussed. Communication is the foundation of the therapeutic relationship; it is the basis of fiduciary and ethical obligations of physicians to patients and their families. Effective health care communication is an essential tool for accurate diagnosis [17][18][19] and for the development of a successful treatment plan, 20-23 correlating with improved patient knowledge, 15,24 functional status, 25,26 adherence to the agreed-on treatment regimen, 20,21,27-32 improved psychological and behavioral outcomes, 15,33-36 and even reduced surgical morbidity. 3,4,37 In the case of distressing news, skillful communication can enable a family to adapt better to a challenging situation, 12,38,39 including a child's unanticipated impairments. [40][41][42][43] Poor communication, on the other hand, can prompt lifelong anger 31,42,44-48 and regret, 14,40 can result in compromised outcomes for the patient and family, and can have medicolegal consequences for the practitioner. 49