Caring For Kids And Their Parents

Connecting Through Kids’ Culture

Scenario Analysis

As a physician caring for children, gaining the trust and cooperation of young patients in the physical exam process is crucial for accurate diagnosis and the delivery of appropriate patient care. These scenarios show both successful and unsuccessful physician behaviors in performing a physical examination.

In Scene 1, the physician encounters a child who is exhibiting stranger anxiety typical for this age. Although the child is the patient, the physician addresses the mother for the majority of the visit and makes minimal effort to establish rapport with the child. Because the doctor did not take time to establish a good relationship with the child, she is fearful of the physician when it is time to conduct the physical exam and therefore does not cooperate. Frustrated, the physician resorts to physically overpowering the child, which enhances the child’s fear and combativeness. Unable to perform a useful physical exam, the physician makes a diagnosis without actual evidence to support it and provides a treatment that may or may not be appropriate for the patient.

In Scene 2, the physician encounters a similarly fearful child. Recognizing the child’s body cues, the physician gently focuses the visit on the child from the beginning. The physician does this slowly, carefully tailoring the conversation to the comfort level of the child. Some children may gladly connect with people, while other children may take some time and may become more distant if the attempt to build rapport is too aggressive. The physician speaks to the child in a gentle tone that is calming and playful and represents a speech pattern that the young patient finds friendly. The physician uses a common favorite character of young children, Dora the Explorer, to engage the child in a playful physical examination, and rewards the child with a “high five” for her cooperation. By performing a successful physical examination, the physician has all the information he needs to accurately diagnose the child’s ear infection and appropriately prescribe antibiotics.

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