Pediatric residents' response to ambiguous words about child discipline and behavior

Abstract

Frequently, doctors have been noted to seemingly ignore or brush off patients' bids to discuss sensitive issues. In some of these cases, however, apparent ignoring could be the result of the doctor mistakenly interpreting the meaning of potentially ambiguous terms used by the patient. This study demonstrates the frequency with which parents use and pediatricians clarify ambiguous terms describing child behavior and physical punishment. Sixty-one (26%) of 234 audiotapes from a systematic cross-sectional sample of non-urgent visits with pediatric residents included at least one episode in which such words were used by a parent. Discussion following each use was classified as: (a) clarifying its meaning, (b) discussing without clarification, (c) ignoring the use of the word, or (d) contradicting the negative attribution. In 61 visits, the parent or child was the first to use the potentially ambiguous term. Physicians clarified 7 (11%) of the terms, ignored 23 (38%), contradicted 7 (11%), and discussed without clarification 24 (39%). Clarifying and contradicting were associated with a shorter doctor-patient relationship than ignoring or discussing without clarification. Doctors who sought clarification were the least dominant. A non-dismissive response to ambiguous words may be a marker for both the stage of the doctor-patient relationship and a doctor's overall interactive style. Considering clarification may be helpful in understanding doctors' responses to patients' cues.