RESUMEN
AIMS: To study how physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties of their patients' children under 18. METHOD: Exploratory and qualitative study based on an in-depth study of interviews. STUDY POPULATION: Thirteen physiatrists or neurologists following brain-damaged patients and 12 psychiatrists following patients with chronic psychiatric disorders. RESULTS: In the two groups of physicians, diversified practices in catering for the issues of the patient's parenthood, child-parent relationships, and difficulties experienced by the child. The child's difficulties are not approached as such. For many of the physicians, representations of the parenting function, and of the child's needs and difficulties are not often used in work with the patient. Patient-centred care appears at odds with catering for the patient's children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in his/her parental functioning and concerns, appear as factors in the reluctance of physicians. Other reasons are lack of familiarity with issues relating to childhood, and the feeling of encroaching on a private and intimate sphere. The representations of physicians with regard to parenthood, parent-child relations, and the needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of physicians' own experience. CONCLUSION: The conflict of values and the uneasiness of the physicians suggest the need for ethical reflection groups or Balint groups.
