• consultation
• patient information
• questions

There is great power in the spoken word and doctors should beware misunderstandings. The first author spent some time in general practice. On a home visit to a man in bed with pneumonia he was bidding farewell to the man’s wife at the front door when she said, “He is still off the greens doctor”. The first author did not understand what she meant. She explained that 20 years previously her husband had had a bout of diarrhoea and vomiting. The senior partner had advised that he should “stay off the greens”—presumably for a short period. For the 20 years that followed not one green leaf had passed this man’s lips. Arguably, the most powerful medical intervention is the spoken word, yet how we communicate with families is little studied.

The hospital clinic is the active point of contact between families, their children, and local paediatric services. From the family’s point of view this is an essential interchange, often viewed with apprehension for many weeks as a result of worry over underlying disease or illness, real or perceived. For the doctor on many services the clinic is a stressful time commitment with a varying agenda: identifying (not missing) significant illness, assuring where appropriate, giving adequate supervision for trainees, and avoiding them too making mistakes. A typical scenario would be:

“the parents in front of you are in tears, the last child no better, trainee at the door with a question, over-running 40 minutes already, and waiting lists growing”

In that interchange between families and doctors moments are precious. Despite best efforts it is easy to get things continuously wrong. The authors found that children with epilepsy attending a clinic continued to misunderstand the nature of their problem.¹ Another dimension was opened up in a study of …