title: Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain.
abstract: OBJECTIVE
  To determine prognostic indicators in children with severe functional abdominal pain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child.
  
  
  METHODS
  Retrospective analysis of a cohort of 23 children aged <16 years fulfilling the Rome II diagnostic criteria for FAP during the period December 1997 to February 2001. Poor outcome was defined as continued pain and failure to return to normal functioning >12 months after onset.
  
  
  RESULTS
  Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families.
  
  
  CONCLUSIONS
  Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child.
authors.affiliation: Department of Gastroenterology, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK. k.lindley@ich.ucl.ac.uk
authors.forename: K J
authors.initials: KJ
authors.lastname: Lindley
authors.forename: D
authors.initials: D
authors.lastname: Glaser
authors.forename: P J
authors.initials: PJ
authors.lastname: Milla
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002651:Child Advocacy; D002662:Child Health Services / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003258:Consumer Behavior; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data