Preserving the child as a respondent: Initiating patient-centered interviews in a US outpatient tertiary care pediatric pain clinic

Authors

  • Ignasi Clemente Hunter College, CUNY
  • John Heritage University of California, Los Angeles
  • Marcia L. Meldrum University of California, Los Angeles
  • Jennie C. I. Tsao David Geffen School of Medicine at UCLA
  • Lonnie K. Zeltzer David Geffen School of Medicine at UCLA

DOI:

https://doi.org/10.1558/cam.v9i3.203

Keywords:

chronic condition, clinician-child-parent triadic communication, medical interview questions, medically unexplained symptoms, patient participation, patient presenting concerns

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.

Author Biographies

Ignasi Clemente, Hunter College, CUNY

Ignasi Clemente received his PhD in anthropology from the University of California Los Angeles and is currently an assistant professor in the Department of Anthropology at Hunter College, CUNY. He has held positions at the University of Southern California and the UCLA Geffen School of Medicine. His research interests include embodied communication in multilingual settings, health communication, sociocultural and communicative aspects of pain and suffering, and childhood studies.

John Heritage, University of California, Los Angeles

John Heritage is Distinguished Professor of Sociology at UCLA. His primary research field is conversation analysis, together with its applications in the fields of mass communication and medicine. He is the author of Garfinkel and Ethnomethodology (1984) and, with Steven Clayman, The News Interview: Journalists and Public Figures On the Air (2002) and Talk in Action (2010). He is also the editor of several volumes and has published over 100 papers on communication and interaction.

Marcia L. Meldrum, University of California, Los Angeles

Marcia L. Meldrum is a medical historian and qualitative health services researcher at the UCLA Center for Health Services and Society, with research interests in pain management, prescription drug evaluation, and mental health treatment services.

Jennie C. I. Tsao, David Geffen School of Medicine at UCLA

Jennie C. I. Tsao is Research Director of the UCLA Pediatric Pain Program and an associate Professor of Pediatrics at the David Geffen School of Medicine at UCLA. Her research centers on psychological factors in children's pain responses within the context of laboratory pain models as well as clinical manifestations of pediatric chronic pain. She is particularly interested in the role of anxiety in pain reactivity and the maintenance of chronic pain in children.

Lonnie K. Zeltzer, David Geffen School of Medicine at UCLA

Lonnie K. Zeltzer, a Distinguished Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at UCLA, is Director of the Pediatric Pain Program. She is the recipient of a Mayday Pain and Policy Fellowship, a Jeffrey Lawson Award for Advocacy in Children’s Pain Relief, and a Clinical Centers of Excellence in Pain Management Award. Her research focuses on pain vulnerability and inhibition in children, with over 350 publications and a book on childhood pain.

Published

2013-09-17

How to Cite

Clemente, I., Heritage, J., Meldrum, M. L., Tsao, J. C. I., & Zeltzer, L. K. (2013). Preserving the child as a respondent: Initiating patient-centered interviews in a US outpatient tertiary care pediatric pain clinic. Communication and Medicine, 9(3), 203–213. https://doi.org/10.1558/cam.v9i3.203

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