How to Talk to Your Child's Doctor

      Doctors are taught to ask about your child's chief complaint in a very open-ended fashion, such as: "What brings you here tonight?" Busy emergency department doctors, unfortunately, are more likely to glance at the nurse's note and say something more direct, like: "So tell me about Johnny's cough." The ideal situation, though, is for the doctor to begin the interview in a neutral, non-directed way, because questions that are too focused in the beginning can easily lead to … misadventures. Asking parents what their child's chief complaint is sets the tone for the whole encounter. It is therefore crucial for parents to answer that important question in their own way. An experienced doctor knows this in the abstract, but sometimes in the press of a busy night forgets. No matter how busy the doctor or chaotic the situation, parents need to make sure the doctor hears their own explanation for why they are there.

   It is also important, vitally so, to understand what the chief complaint is not — it is not a specific diagnosis, because that implies a conclusion. Many parents, and sometimes busy physicians, fall into the trap of describing the chief complaint in these terms. Perhaps your child has asthma and has needed frequent visits to the doctor for breathing treatments. On this particular night, he is having breathing problems again, and you take him to the emergency department. You have been through this scenario many times before, and the problem has always been a flare in his asthma. When the nurse, and then the doctor, asks why you are there, you say: "His asthma is acting up again."

   That is not the best answer, because it is a conclusion, a diagnosis, not a symptom. Even though you are probably right — it very likely is asthma — the best way to answer the question of "why are you here" is not "asthma;" the best way to answer the question is "difficulty breathing." My point is that the chief complaint is just that — what the patient is complaining about. What hurts? What does not feel right? What is bothering your child?

   The chief complaint is either a symptom, like abdominal pain or difficulty breathing, a physical sign, like a lump on the neck or a rash, or both together, like an itchy rash or a painful lump. In our example, most of the time difficulty breathing in a known asthmatic will turn out to be caused by asthma. But sometimes it will be something else, and it is a mistake to begin the medical history with an assumed conclusion; it is one of the many things that can lead to bad communication between patients and doctors.

   Once the doctor is clear on what the chief complaint is (and you should not go on with the interview until you are sure this is the case), the next part of the medical history is called the history of present illness, often abbreviated as HPI. It is a detailed discussion of your child's chief complaint. The doctor will often begin by asking a parent some open-ended questions like "tell me about the pain" or "describe the rash for me," but this is the point in the process where the open-ended quality of questioning ends. The doctor has a very controlled agenda, and a parent should not be surprised if she keeps a fairly tight rein on the discussion from this point on. In a sense, the interview moves from the parent-directed chief complaint to the more physician-directed aspects of the rest of the history.