Physician-patient trust

Physicians meeting a child and family for the first time must inspire confidence, display empathy, and develop trust while providing knowledgeable, evidence-based care, meeting diagnostic challenges, and, often, coordinating consultation from multiple services.

As Osama Almadhoun, MD, makes clear in this month's issue, the importance of trust in the parent-physician relationship is not limited to the inpatient, referral hospital setting.

Once organic causes are excluded by a careful history and physical examination and, perhaps, some simple laboratory studies, treatment begins with reassurance and empathy on the part of the physician that the symptoms are valid. Parents and patients for their role should trust that their physician is not only competent and well informed but also shares their concerns and will work with them over time to minimize the effect of abdominal pain on the child's life.

It may be tempting to order imaging studies and extensive laboratory tests to provide reassurance that there is no organic cause for the abdominal pain. In fact, testing may be what the parents expect.

Pediatricians who have the advantage of an existing relationship with the family, however, should be able to build on the confidence that has been established during previous office visits-confidence on the part of parents that their pediatrician is concerned about the health of their child and that he or she will continue to be available.

Chronic abdominal pain is, of course, only one of the many conditions and situations that test the pediatrician-parent relationship. Effectively alleviating concerns regarding possible harm from immunizations, explaining the ineffectiveness of antibiotics for treatment of viral respiratory complaints, and even reassurance regarding everyday concerns about growth and behavior problems-all have the potential to challenge parental confidence.

Almadhoun's article reminds us, however, that patient outcome, relief of symptoms, and even reduction in medical costs depend on a privileged relationship built on trust.

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