title: Preserving the child as a respondent: initiating patient-centered interviews in a US outpatient tertiary care pediatric pain clinic.
abstract: This article identifies some of the challenges of implementing patient-centeredness in multiparty clinical visits. Specifically, it describes four interview practices with which clinicians address these challenges in a US outpatient tertiary care pediatric pain clinic. Using the qualitative method of conversation analysis, we analyze clinicians' child-directed (ages 10-18) interviewing during the initial stage of 51 intake visits. In particular, we analyze the challenges involved in open-ended questioning, a form of interviewing associated with patient-centeredness. Open-ended questioning presents participants with competing demands: although it gives children an opportunity to talk about their illness in their own terms, it also asks them to be responsible for a larger part of the communication work. Moreover, the presence of a parent as an alternative informant can lead to the loss of the child as an informant if clinicians fail to give the child, particularly younger ones, enough guidance in answering. We argue that a flexible range of interviewing practices may be a step towards offsetting children's and parents'past negative experiences with clinicians, improving patient outcomes and implementing child/patient-centeredness.
authors.affiliation: Department of Anthropology, Hunter College, CUNY, New York, NY 10065, USA. iclement@hunter.cuny.edu
authors.forename: Ignasi
authors.initials: I
authors.lastname: Clemente
authors.affiliation: Department of Sociology, UCLA, 90095-155103, USA.
authors.forename: John
authors.initials: J
authors.lastname: Heritage
authors.affiliation: UCLA Center for Health Services and Society, Los Angeles, CA 90024, USA.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Meldrum
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, 90095-1752, USA.
authors.forename: Jennie C I
authors.initials: JC
authors.lastname: Tsao
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, 90095-1752, USA.
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
mesh_terms: D000293:Adolescent; D002648:Child; D003142:Communication; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D010045:Outpatients; D018710:Pain Clinics; D010290:Parents; D018802:Patient-Centered Care / Q000379:methods*; D010372:Pediatrics; D010817:Physician-Patient Relations; D014481:United States