Mapping Interpersonal Communication between Pediatricians and Mothers: Understandings, Interdependencies and Gaps

Abstract

Interpersonal communication between pediatricians and mothers is both complex and interdependent. The mother is dependent on the pediatrician for her child’s wellbeing and care along expertise-related dimensions for which she cannot provide. The pediatrician is dependent on the mother’s ability to provide accurate information about the child’s health and habits, so that the doctor, who has limited time with the child, is able to make continuing accurate diagnoses. This paper seeks to provide a basic understanding of interpersonal mis-/communication between mothers and pediatricians, a complex area which has not heretofore been mapped in the contemporary Indian context. Therefore, the paper presents a small-scale exploratory qualitative study based on in-depth interviews with both doctors and mothers in the city of Kolkata (Calcutta), India. It focuses on providing an understanding of the factors that may enable or disenable instrumental or relational communication in the mother-pediatrician situation. Four major themes emerge from the data: first, the shifting borders of information between pediatricians and parents; second, the respective roles of verbal and non-verbal communication in the consultation; third, a tension between the traditional and the modern; and fourth, understandings of professional and interpersonal relationship in the context of responsibility for a child.

Appendices

Appendix 1

Mapping Interpersonal Communication between Pediatricians and Mothers

PI: Devalina Mookerjee

Semi-Structured Interview Instrument for PEDIATRICIANS

Demographics

• a. Name

• b. Age (approx)

• c. Gender

• d. Qualifications

• e. No. of years in profession

• f. Locations of Practice

  • i. By time period

  • ii. By clinics/sites of visit

• g. Approx. no. of patients seen in a day/week/month (appointments + clinic visits)

• h. Brief patient demographics across practice

Since you are dealing with parents, principally, I am looking for a thumbnail cultural orientation to the kinds of parents you deal with:

• Professional (in terms of class, income etc.)

• Personal (in terms of HUF/nuclear; Bengali, or non; language of interaction)

Mapping the Health Relationship

• 1. At which point does a paediatrician normally enter a family’s life

• 2. How long does the relationship last? On what basis does the relationship end (child grows, any others?)

• 3. Which parent do you have to deal with the most often?

  • a. Why do you think it is normally this parent?

  • b. Does this sort of communication situation lead to communication problems? (Dr.-mother-family)

• 4. How informed do mothers tend to be, about pediatric issues and problems (common problems → rarer but specific problems of a child)

  • a. Where do they get this information from?

    • i. What is usually the quality of the information parents bring into your office?

      • 1. Divided into traditional remedies for minor ailments, and internet based information for more serious illnesses

      • 2. Good information in which areas usually, and bad or low grade info in which others?

      • 3. PROBE the role of household ‘totkas’. Are these sometimes useful? When?

• 5. If I was to ask about the most common childhood ailments that you encounter

  • a. Are these more or less avoidable, if certain basic measures are taken, or are these an inevitable part of childhood?

Communicating with Mother

BASIC: How many roles do you think you fulfil as a pediatric doctor? (advisor, diagnostician, reassurer, information provider, disciplinarian etc.)

• 6. What are your basic expectations of a care giving parent? Do you have to brief patients on either a. Or b.? At the beginning? Over the course of the relationship?

  • a. Basic expectations

  • b. Higher-order expectations

• 7. What do you think their expectations are of you, as their child’s doctor?

• 8. Four basic communication styles for pediatricians, 1. Information giving, 2. Interpersonal sensitivity, 3. Partnership, 4. Directing one’s own treatment

  • a. Mother’s personality: 1. Openness to experience, 2. Extraversion, 3. Neuroticism

  • b. Guilt and blame

  • c. Maternal stress and depression

  • d. Communication barriers: Common and infrequent

  • e. Misunderstandings: what are the points at which patients tend to misunderstand diagnosis, instructions etc.? What steps can a pediatrician take to prevent these misunderstandings?

• 9. A communicative point is the revealing of diagnosis and prognosis. How do you know in what ways a patient prefers news and information. And perhaps bad news?

• 10. This issue of the recent crib deaths and other infant deaths in the public healthcare system in West Bengal.

  • a. Possible causes, institutional and personal

Appendix 2

Mapping Interpersonal Communication between Pediatricians and Mothers

PI: Devalina Mookerjee

Semi-Structured Interview Instrument for MOTHERS

Demographics

• a. Name

• b. Age (approx)

• c. Gender

• d. Occupation

• e. No. of children

  • i. Age, gender

• f. Location of family

  • i. By time period

• g. Approx. no. of pediatrician visits in a week/month

  • i. Reasons for visits

• 2. Is this the pediatrician you started out with? Did you change? If so why?

  • a) Do you have different pediatricians for different situations (regular/emergency)?

Mapping the Health Relationship

• 1. At which point did your pediatrician enter your family’s life?

• 2. How long will the relationship last? On what basis will the relationship end (child grows, any others?)

  • a. Would you change your current pediatrician for any reason?

• 3. Do you normally go alone for pediatrician visits?

  • a. In what kinds of situations may the other parent (or other family members) be brought in? Does bringing others into the consultation this ever involve problems?

• 4. How informed do you think you are, about pediatric issues and problems (common problems → rarer but specific problems of a child)

  • a. Where do you get this information from?

    • i. Books, TV, word of mouth (traditional and from peers)

• 5. How does your pediatrician react to the information you bring in, based on your own sources of information?

  • i. Divided into traditional remedies for minor ailments, and internet based information for more serious illnesses

• 6. PROBE the role of household ‘totkas’. Are these sometimes useful? When?

  • a. Which totkas do you commonly use?

  • b. Do you inform your pediatrician about using totkas?

• 7. What are the most common childhood ailments that you see in your child and her/his peers

Communicating with Mother

BASIC: How many roles do you think you fulfil as a mother, from the point of view of your pediatric doctor? (information provider, disciplinarian, carrier-out of instructions etc.)

• 8. What are your basic expectations of a pediatrician? Do you, as a mother, expect competent and detailed briefs on a. Or b.? At the beginning? Over the course of the relationship?

  • a. Basic expectations

  • b. Higher-order expectations

• 9. EXTENDING:

  • a. How does your pediatrician normally gather information from you? Counsel you on child related worry (examples)?

• 10. Four basic communication styles for pediatricians, 1. Information giving, 2. Interpersonal sensitivity, 3. Partnership, 4. Directing one’s own treatment. Which do you prefer? Which does your pediatrician prefer? Is there a match?

  • a. Mother’s personality: 1. Openness to experience, 2. Extraversion, 3. Neuroticism. Comment on this study?

    • i. Guilt and blame

    • ii. Maternal stress and depression

• 11. Communication barriers: areas that need extra effort to put information through.

  • a. Misunderstandings: Common and specific (examples)

• 12. A communicative point is the revealing of diagnosis and prognosis. In what way do you prefer news and information. And perhaps bad news?

  • a. Direct or indirect? Sugar coated or straight? In euphemisms or not?

• 13. This issue of the recent crib deaths and other infant deaths in the public healthcare system in West Bengal.

  • a. What do you think could be possible causes, institutional and personal.