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Parents and children are mostly passive during pediatric visits

Most parents and children at pediatricians' offices accept the doctors' treatment recommendations without discussion, even though studies have shown that patient participation results in better outcomes. Elizabeth D. Cox, M.D., Ph.D., and colleagues at the University of Wisconsin reviewed videotapes of 101 visits to 15 physicians for pediatric complaints, mostly upper respiratory symptoms.

Doctors on average spent 2.9 minutes offering 4.1 treatment plans during each visit. For most encounters (89 percent) the doctor proposed treatments, and 65 percent of parents and children accepted the doctor's recommendation with no discussion of their preferences. Parents proposed treatments in 9 percent of the encounters, and children took part in discussions 2 percent of the time.

Parents and children were less inclined to stay silent during longer visits, which usually entailed more treatment plans and more discussion. Researchers also found that discussion of treatment options occurred most often when the doctor and patient were female and the doctor had been practicing for several years.

These results show the need to develop ways to improve parent and child participation in health care decisions. Having the patient, parents, and doctors take part in making decisions is preferable to silence, especially when treatments pose some risk. The researchers suggest that more work needs to be done in developing participation skills during childhood.

This study was funded in part by the Agency for Healthcare Research and Quality (HS13183).

See "Evaluating deliberation in pediatric primary care," by Dr. Cox, Maureen A. Smith, M.D., Ph.D., M.P.H., and Roger L. Brown, Ph.D., in the September 24, 2007 Pediatrics 120, pp. e68-e77.

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