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Child/Adolescent Health

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Pediatricians often do not pursue answers to questions that arise during medical visits

During one in five medical visits, pediatricians are unable to answer questions that arise from the patient or that are prompted by the patient's condition/situation. An example is, "What is the role of hormone therapy in undescended testicles in a young boy?" Visits by children with special health care needs (CSHCN) generate more unanswered questions than visits by children without special needs. Doctors also deem these questions (usually about diagnosis and treatment) more important than other questions. Yet, doctors pursue the answers to only about one-fourth of these questions, both overall and for CSHCN.

These are the findings of a new study supported by the Agency for Healthcare Research and Quality (HS11826). The researchers observed 890 visits (19 percent with CSHCN) with 35 general pediatricians. Parents completed a CSHCN screener. Physicians provided details about their unanswered questions and their pursuit of answers. Of the visits, 19 percent prompted unanswered questions. Of these, the physicians deemed 60 percent to be important or very important.

Physicians intended to pursue answers to half of the questions, but actually pursued answers for only 27.5 percent. They cited lack of time and inadequate information resources as barriers to getting the information needed to answer the questions. Unanswered questions arose nearly twice as often with CSHCN than children without special needs (28.7 vs. 16.9 percent), and over twice as often during well visits (34.6 vs. 14.9 percent). This is probably because general pediatricians have seen few patients with the uncommon conditions suffered by CSHCN. Scheduling more time or more visits for CSHCN may help overcome barriers to answering these often important questions related to children's care, suggest the authors.

More details are in "Unanswered questions prompted during pediatric primary care visits," by Chuck Norlin, M.D., Adam L. Sharp, M.D., and Sean D. Firth, Ph.D., M.P.H., in the September-October 2007 Ambulatory Pediatrics 7(5), pp. 396-400.

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