Psychology and the enhancement of pediatric care
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COMMENTARY
Psychology and the enhancement of pediatric care Rolando G. Gerena 1 & Richard B. Gunderman 1 Received: 28 August 2020 / Revised: 28 August 2020 / Accepted: 6 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
All radiologists who participate in the care of pediatric patients are familiar with the uncooperative patient — an infant who refuses to drink contrast agent, a toddler who will not lie still for a US examination, or a preschooler who resists urethral catheterization for a voiding cystourethrogram. It is easy to become resigned to such situations, according them little attention or reflection. But doing so would represent a lost opportunity. The ways pediatric patients react to their experiences in the radiology department offer deep insights into the perspectives of children and adolescents, and gaining a better understanding of their psychology opens opportunities to enhance care. We need but ask the simple question, “Why might a child resist, cry or fail to cooperate with a technologist, nurse or radiologist?” What might appear nothing more than fatigue, fear or obstinacy might in fact reflect deep and complex sensitivity or sense of vulnerability. For example, a child might have good reason to regard the sight of an approaching catheter or needle as a threat. After all, even the health professional wielding it knows that it is likely to cause discomfort or pain. Children, like adults, fear harm, and their past experiences and intuitions about what might prove distressful are often well founded [1]. Radiologists need to look beyond mere behavior and attempt to understand what the operations of the radiology department look like from the point of view of children, as well as their parents and siblings. When children “fail to cooperate,” it is often because they do not understand, and in the case of especially young children or those with disabilities, because they are not developmentally equipped to understand. Of course, to say that children do not understand often really
* Richard B. Gunderman [email protected] 1
Department of Radiology, Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, IN 46202, USA
means that they understand differently — they experience the world from a different perspective that, though at variance with an adult health professional’s point of view, might be every bit as rich and complex. Consider, for example, seemingly fundamental concepts such as health, disease, prognosis, treatment and death. Some radiologists might suppose that such terms mean the same thing to everyone, but in fact they are likely to be understood very differently by children of different ages, developmental stages and life experiences. To a physician, health might mean, among other things, the absence of diagnosable disease. To a child, however, health might mean feeling good, and many diagnostic procedures and therapeutic interventions such as confinement, discomfort and pain appear to be direct assaults on well-being.
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