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Perceptions Often Become Realities

Mindful communications are always important between patients and healthcare providers. I remember once telling a family member “you have a lesion”. The look of horror upon their face as if I handed off a death sentence. I had to explain “listen it is just a structural change in the body – the skin.” I added further “a blister is a lesion, a scab over a scrape is a lesion.” Now imagine a parent with a child. Better yet I would like you to picture a first time parent with a child visiting a physician and being told about various medical conditions and or ailments. An infant’s smile will warm a parent’s heart; consequently a baby’s discomfort would cause much dismay to the parent’s heart and mind. It should not surprise anyone that researchers who have studied the reactionary behaviors of parents regarding their child’s health have found that the use of certain words do have an impact.

Understanding a Doctor’s Diagnosis

An article from[i] (Phend, Disease Tag Prompts Parents) discusses a study conducted at a pediatrician’s office where parents were given a scenario about a one month old child. The study was conducted by a group of researchers from the University of Missouri in Columbia. Researchers provided a scenario where their one month old child spits up and cries excessively after eating. The 175 participants were presented with one of four possible outcomes, all describing the condition and asking the parents’ desire for medication to treat the problem. Some labeled the medical condition as a disease, gastroesophageal reflux disease (GERD), while others simply described it the symptoms of the baby. In addition, some scenarios mentioned that the medicine was often ineffective. Researchers found that parents who received scenarios labeling the condition were more likely to want to treat with medication. According to a Reuter’s article, also from April 1, 2013[ii], parents who knew the condition’s name rated in interested in medication at a 2.5 out of five even though they were told the medication was not effective. On the other side, the parents who saw the description of symptoms and were told medicine didn’t help rated their interest below a 1.5 out of 5.

I would agree with the researcher’s conclusion just from my own practice, the notion that the parents’ decision making process on the selection of medical treatment options is impacted by how a physician presents their diagnoses. The study reports “This is compelling evidence that the choice of words by physicians can significantly affect parents’ views of their children’s health,” wrote William Carey, MD, of Children’s Hospital of Philadelphia (Phend, Disease Tag Prompts Parents). The Medpagetoday article noted, “The GERD label didn’t make parents report a higher level of worry about the child or perceive the illness as more severe, which meant it exerted its effect on their assumptions about appropriateness of interventions.” Both articles state that many consider GERD over-diagnosed, given that spitting up is normal for children under six months because many have an underdeveloped stomach valve which allows food and acid back up into the baby’s mouth. GERD can only be properly diagnosed through an invasive endoscopic procedure, yet there are an increasing number of babies diagnosed with the condition, many without proper diagnosis.

Choosing the Right Medical Treatment

Physicians and patients must understand the consequences of a patient condition treated as a disease versus a normalized adjustment period required. Physicians need to be careful of how they present information to parents, and parents need to make informed decisions about their children’s medical treatment options.

Bottom line
The old adage applies “There is no such thing as a dumb question.” In healthcare it is all about asking the right question. Here are some simple guidelines:
1. Clarify the exact diagnosis and etiology (which means what are the problem and the cause of the problem).
2. Once the diagnosis is reported – confirm, “Is this a symptom or an actual condition?”
3. If your child has more than one condition, have the provider itemized the treatment by diagnosis.
4. If you do not understand the condition or the treatment ask the provider to explain it again in simple terms.
5. If you still do not understand you can repeat steps 1 – 4 and or perhaps consider a second opinion.





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Rebecca S. Busch, Healthcare Advocate

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