Faculty Bibliography

OBJECTIVE: To describe pediatricians' self-reported experiences with health literacy, use of basic and enhanced communication techniques, and perceived barriers to effective communication during office visits. DESIGN/METHODS: A national, random sample of 1605 nonretired, posttraining American Academy of Pediatrics members were surveyed in 2007 about health literacy and patient communication as part of the Periodic Survey of Fellows. The response rate was 56% (N = 900). RESULTS: Eight-one percent of the pediatricians were aware of a situation in the previous 12 months in which a parent had not sufficiently understood health information that had been delivered to him or her. In addition, 44% of all pediatricians were aware of a communication-related error in patient care within the previous 12 months. Using simple language (99%), repeating key information (92%), and presenting only 2 or 3 concepts at a time (76%) were the most commonly used communication strategies. Enhanced communication techniques recommended by health literacy experts such as teach-back and indicating key points on written educational materials were used less often (23% and 28%, respectively). The most common reported barriers to effective communication were limited time to discuss information (73%), volume of information (65%), and complexity of information (64%). The majority of physicians rated themselves highly in their ability to identify caregiver understanding (64%), but only 21% rated themselves as very good or excellent in identifying a parent with a literacy problem. Fifty-seven percent of the respondents were interested in training to improve communication skills, and 58% reported that they would be very likely to use easy-to-read written materials, if available from the American Academy of Pediatrics. CONCLUSIONS: Pediatricians are aware of health literacy-related problems and the need for good communication with families but struggle with time demands to implement these skills. Despite awareness of communication-related errors in patient care, pediatricians report underutilizing enhanced techniques known to improve communication

What price the not-skinny doctor? 'The advice we're supposed to give in pediatric clinic, it boils down to 'Eat less, exercise more,' ' said Dr. Julie C. Lumeng, an assistant professor of pediatrics at the University of Michigan Medical School and an expert in childhood obesity. [...] Dr.\n

'The advice we're supposed to give in pediatric clinic, it boils down to 'Eat less, exercise more,'' said Dr. Julie C. Lumeng, an assistant professor of pediatrics at the University of Michigan Medical School and an expert in childhood obesity. 'This is such blasphemy, but when I deliver this advice to families, my heart's not in it, because I just feel like so often the families are just glazing over, and when that advice is delivered to me, I glaze over, too.' 'I know it all, I do research in this,' she went on. 'But in the moment I'm exhausted, it's been a long day at work, everyone's sort of irritable. You can know what you need to do, but when the moment comes ...' In the end, Dr. Lumeng is left with the same advice that made her glaze over: 'I've had patients who say to me, 'Wow, doctor, you've really lost weight -- how did you do it?' And I have to say, 'Well, I exercise more and I eat less!''

First the casual inquiry, one parent to another: If a child in middle school is stealing money, you have to worry, already, about drugs and alcohol and the other influences in that child's life. [...] what about true antisocial behavior? A young child's stealing is in no way the equivalent of setting fires or torturing animals or any of the other frightening prospects that flash across some parents' minds in that first did-I-just-see-you-take-something-from-the-store moment

Certain subjects make self-righteous parents of us all: our children thinking they are doing homework when in reality the text messages are flying, the Internet browsers are open, the video is streaming, the loud rock music is blaring on the turntable -- oh, wait, sorry, that last one was our parents complaining about us. [...] I decided to test my digital immigrant biases -- which tell me that no one can study effectively while watching, listening, surfing, messaging -- against my professional experience, which tells me that medical students who don't study effectively can't learn the huge and complex body of material they have to master, and will therefore not pass their frequent tests

In our house we had gone through the usual process, but I had no idea how usual it was. First the casual inquiry, one parent to another: Did you take any money out of my wallet? Then the little rat's nest of bills accidentally discovered in the seven-year-old's room. The worrying, the questioning, the self-doubt: How do we handle this? What does it mean? Does this tell us something we don't want to know about our child's character? About ourselves? 'Kids are trying to find out what happens if you get caught. And if nobody catches them and says, 'That's wrong, you have to give that back or pay for it,' they don't get a sense of being properly supervised,' [Barbara Howard] said. Dr. Martin T. Stein, another expert at the University of California San Diego/Rady Children's Hospital, used a favourite pediatrician's phrase to talk about those five-to-eight-year-olds who steal: 'It's really a teachable moment.'

'Too many parents are haunted by experiences both good and bad that they identify with their birth order,' said Dr. Peter A. Gorski, a professor of pediatrics, public health and psychiatry at the University of South Florida. [...] that might lead them to classify their own children according to birth order, he went on, which in turn can lead to a sense of identification or even rejection and to 'self-fulfilling prophecies.'

'Too many parents are haunted by experiences, both good and bad, that they identify with their birth order,' said Dr. Peter A. Gorski, a professor of pediatrics, public health and psychiatry at the University of South Florida. Birth Order, Family Dynamics and Creative Lives (Pantheon, 1996), points out that second-born children tend to be exposed to less language than eldest children.