How do paediatricians communicate with children and parents?

AIM: The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor-parent-child communication in the outpatient setting. METHODS: Fifty-one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions. RESULTS: Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%). CONTROL: Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor. CONCLUSION: Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient-centred approach.

A current study of parasuicide in Durban.

Between 1 January and 31 December 1978, there were 723 episodes of overdosage, poisoning, self-inflicted injury and other possible manifestations of parasuicide reported by the casualty and trauma units of Addington Hospital, Durban. The Department of Psychiatry at this hospital attended to 310 of the patients involved. The study represents an analysis of their characteristics, which might indicate those at greatest risk of parasuicide. Some of the more relevant findings include the following: women predominated, those most at risk were in the age group 20--29 years, and single people were more at risk. The most common method of parasuicide was the ingestion of benzodiazepines and analgesics. A seasonal fluctuation was noted with a referral peak during the summer months, viz. December--February. Transient situational disturbances, reactive depression and conduct disorders in adolescents were the most prevalent psychiatric diagnoses.

The management of parasuicide in adolescents.

Recent research has disclosed that conduct disorders make up one of the most common conditions currently seen in child and adolescent psychiatric clinics. Epidemilogical studies also show a steady increase in the incidence of both conduct disorders and adolescent parasuicide, although rates vary from area to area. A study undertaken during 1978 on patterns of parasuicide revealed its second highest incidence to be within the age group 10--19 years. A significant percentage of these episodes in adolescents was diagnosed as conduct disorders. There may be a relationship between conduct disorders, parasuicide in adolescence, and our modern technocratic society with its 'growth in rapid change', although the precise nature of this relationship remains to be elucidated. Guidelines for management are presented, based on the dynamics of suicidal behaviour. Because of the shortage of child psychiatrists, clinical psychologists and treatment facilities, specifically for adolescents, the primary care physician still often finds himself in the front line of the management of parasuicide.