Jump to comment:

• Paediatric training for GP's
  Rajashree Ravindran
  Published on: 22 March 2016
• Taking on the parents´ perspective
  Thorsten Langer
  Published on: 22 March 2016

• Published on: 22 March 2016

  Paediatric training for GP's

  • Rajashree Ravindran, Paediatric Registrar

  I read with interest the article ‘making choices: why parents present to the emergency department for non-urgent care’ published in ADC journal in the October 2009 edition. Amongst the reasons mentioned for coming to PED, a total of 26 parents (18%) responded that they were either unhappy or wanted a second opinion for their child’s condition. It is this group of patients who increase the workload of staff and waiting time...

  Show More

  I read with interest the article ‘making choices: why parents present to the emergency department for non-urgent care’ published in ADC journal in the October 2009 edition. Amongst the reasons mentioned for coming to PED, a total of 26 parents (18%) responded that they were either unhappy or wanted a second opinion for their child’s condition. It is this group of patients who increase the workload of staff and waiting times in A&E. I agree that very child had the right to health, but sometimes the parents’ perspective of ‘childhood illness’ can be quite demanding to deal with. So many of us would have come across parents who wait with their ‘unwell’ kids in A&E for nearly 3 ½ hours and finally decide to leave only when the doctor’s wait is going to take an extra 10-15mins. I empathise with such parents because strong emotions can completely cloud your judgement and make you behave in a totally inappropriate manner.

  In the UK, the NHS has a good system of primary care, but it would be helpful to communities to have a GP who has some paediatric experience. All the seemingly well children who present to A&E could be dealt with by their GP surgery or the GP walk in centre (Out of Hours service) if they are equipped with adequate skills in clinical Paediatrics. Paediatric work experience should become mandatory for all GP trainees as this would restore the confidence of parents in their own doctor.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 22 March 2016

  Taking on the parents´ perspective

  • Thorsten Langer, MD
  • Other Contributors:
    • Vera Kalitzkus

  With great interest we read the study of Williams et al eliciting the reasons for the presentation of children in non-urgent cases in an Australian paediatric emergency department (PED), a problem also well known in other countries. They found that parents’ presenting behaviour is appropriate according to the level of seriousness of the child’s state they perceive.

  We absolutely agree with the authors’ results...

  Show More

  With great interest we read the study of Williams et al eliciting the reasons for the presentation of children in non-urgent cases in an Australian paediatric emergency department (PED), a problem also well known in other countries. They found that parents’ presenting behaviour is appropriate according to the level of seriousness of the child’s state they perceive.

  We absolutely agree with the authors’ results and conclusion. However, we would like to comment on two aspects. First, the parents’ care giving measures before presenting to the PED are defined in a rather narrow way. Use of medication, first aid measures and consultation of other medical services are items that focus exclusively on the medical context. Especially in the case of fever which represents 20.4% of the reasons why parents present an ill child to the PED in Williams’s study this seems to be relevant.

  In a study of the fever concepts of German and Turkish mothers we found that mothers frequently apply various non-pharmacologic measures, e.g. sponging, complementary medication but also religious and ritual practices before consulting a doctor. These strategies often reflect different explanatory models (1) the parents have for the illness. We found for example that 29% of the mothers use additional blankets when a child has fever. Furthermore 36% stated that cold weather causes fever - a finding that explains the use of blankets as a means to achieve a temperature equilibrium. By asking for items that solely represent the established medical model one misses other concepts that might influence the use of professional services.

  Second, to provide a better understanding of the parents’ motivations and the actions they undertake before presenting to a PED - the explicit goal of the study in question - we believe it is important to take on the parents’ perspective. For this we would suggest for further studies to incorporate a qualitative approach. As long as the wide range of parents’ motivations is not known - and Williams et al seem to interpret them rather narrow - a qualitative approach which enables new insights into the unique perspective of parents seems promising. Questions like why parents present to the PED after having consulted a GP or why they judge the state of the child as serious (and others with the same condition do not) could be answered. Cultural influences might be analysed as well.

  In that sense Williams et al’s work leads to further questions that seem to be important in order to gain a deeper understanding of the parents’ behaviour in seeking help for their child. Eventually, this knowledge could be used to address parents’ concerns effectively, to provide specific information for them and hereby increase the quality of patient care.

  Th. Langer, V. Kalitzkus. Email: thorsten.langer@uni-wh.de

  References: 1) Kleinman, A. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine and Psychiatry. Univ of California Pr; 1981.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top