Children in chronic pain: promoting pediatric patients' symptom accounts in tertiary care.
This paper examines how clinicians promote pediatric patients' symptom accounts at the beginning of visits in three pediatric tertiary care clinics at a university hospital in the United States: pain, gastroenterology and neurology. Quantitative and qualitative data were collected for 69 patient-parent pairs, including videotaped intake visits. Two forms of child account promotion, together with their corresponding distribution across clinics, were identified: (1) Epistemic prefaces were used to upgrade the patient's epistemic status and to establish the child as primary informant; and, (2) non-focused questioning was used to permit children latitude in the formulation of symptoms and experiences. In general, epistemic prefaces were characteristic of the gastroenterology and neurology visits, while non-focused questioning was found overwhelmingly in the pain encounters.
Clemente
Ignasi
I
Department of Pediatrics, University of California, Los Angeles, CA, USA. iclemente@mednet.ucla.edu
Lee
Seung-Hee
SH
Heritage
John
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services; D002908:Chronic Disease; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D018710:Pain Clinics; D010147:Pain Measurement / Q000379:methods*; D010290:Parents / Q000523:psychology; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations