CHAPTER SEVEN: BUILDING RELATIONSHIPS AND TRUSTING PROFESSIONALS
Introduction
7.1 The previous chapter focussed on aspects of the physical environment; this chapter outlines what the children and young people said about the health professionals they came in contact with, or about their ideal doctor or nurse and therefore focuses much more on relationships and what makes these good.
7.2 The children and young people were asked to list the different health professionals they went to see. The doctor, the dentist and the nurse were the 3 most commonly referred to. They were then asked what was good, and what was not so good, about the people they went to see about their health. Some of the younger children also did an activity where they drew a picture of a doctor and divided him or her in two, posting notes listing the 'good things' about the doctor on one side and the 'not so good' things on the other (an example is included in 'Our Words and Pictures' Annex 3). Disabled children also made reference to specialist services they used, most commonly going to see the orthotist (to get splints fitted) or seeing their physio.
Good things about Doctors
7.3 Children and young people said positive things about doctors for different reasons. These were about four different aspects of doctors being 'good' or the child/young person having a good relationship with their doctor. These four features were: the doctor as healer; good communication with the doctor; the doctor being friendly; the treats associated with the doctor. Some of the young people also made reference to what their ideal doctor would be like.
The doctor as healer
7.4. Younger children were more likely to comment on the helping and healing role of doctors when discussing what was good about them.
If you're like ill or something, sometimes they can save your life (Lily, 8)
They can stop people being sick (Alex, 9)
He helps me (Archie, 7)
They help you (Roslin, 8)
7.5 One disabled child said 'they help you move' (Lily, 8). Older teenagers were less likely to respond in this way. One young person spoke positively about the way doctors 'help you' and 'tell you what's wrong', while another also said what was good about them was 'they tell you what's wrong'.
Good communication and friendly
7.6 A few children and young people said that what they liked about doctors was the way they talked to you. Stuart (8) said 'they speak to you nicely' and Lily (8) said 'sometimes they talk to you nicely when you're having something done' which another child in the group agreed with.
7.7 Some of the children and young people also commented on doctors being friendly:
Some of them were nice and smiley (Tiandra, 6),
They're funny sometimes (Emily, 8),
You feel nice and comfortable because they're really nice (Amy, 8),
They're sometimes friendly, polite (Claire, 15)
7.8 When speaking about hospitals, sometimes the doctors being 'nice' had contributed to the positive aspects of the experience. Amy (8), for example, spoke of her favourite room being Ward 1 because the play specialist was there but also because 'the doctors tended to be quite nice as well'.
Treats associated with the doctor
7.9 A few of the children thought that doctors were good because of the treats they gave you or that you got when you saw them. Amy (8) told us that she had to got for lots of blood tests and how
The doctors and nurses were really nice because they gave you a big box of things you could choose from and I got one every time (Amy, 8)
Emily, 8, said that she liked the doctor because he gave her a pound coin. Tiandra (6) said 'I like the doctors because they give us sweets'.
Ideal doctor
7.10 Some of the young people described what their ideal doctor would be like. Suggestions were: 'treats you like your age and no younger', 'funny', 'cool', 'ace', a woman (5 young people), a man (1 young person), 'quite young', 'someone who was quite nice so you were able to speak to them', 'early 20s to late 30s'.
Not so good things about Doctors
7.11 The 'not so good' things about doctors reported by the children and young people were usually associated with treatment, poor communication, unfriendliness, or environment (as previously described).
Treatment
7.12 Children and young people often talked about treatment they didn't like when asked about doctors. Hamish (9) didn't like the way doctors 'took the blood out of you', while Stuart (8) said he didn't like it when they took 'his pee' or when he had earache and they ' forced' him to 'put this thing in my ear'. Claire (15) didn't like how her doctor always had cold hands and didn't like having to get undressed in front of the doctors. Several children said they really didn't like getting injections, and seemed to associated 'getting jags' with the doctor. Millie (9) didn't like having to take her clothes off 'especially if it's a male doctor'. Several children in the same discussion group agreed with her about this. One young person (15) felt the doctors treating her in A&E had been rough and that treatment was sore for this reason.
Communication and friendliness
7.13 While some of the children and young people thought that their doctor spoke to them nicely, some felt that doctors didn't speak to them nicely or that 'sometimes they do and sometimes they don't' (Tom, 11). Auden (10) commented that it depended on 'what mood the people are in' and that one thing that made staying in hospital not so good was when the staff were in a bad mood.
7.14 One young person described being put off going to her doctor ( GP) because he was ' nasty, cheeky and cocky', while 3 participants in a discussion group of 6 - 8 year olds described being scared of doctors. Amy (8) said, about the doctors at the children's hospital, that 'some of them were smiley and some of them weren't' and described the way doctors talked to her:
The doctors were some of them…talked in a very deep voice, and they didn't really kind of do they just talked to you and they told you like all the bad things first and kind of they weren't very kind of happy (Amy, 8)
Perhaps for this reason, Amy described the doctors as sometimes ' dark'.
Stuart (8) didn't like when doctors spoke in a 'grumpy' voice.
I don't like grumpy doctors, sometimes they don't do a nice voice they go come over here! Time for your blood shot! (Stuart, 8)
Two of the young people described being worried about what their doctor was going to tell them
You don't know what they're going to say, they could say you're dying (Claire, 15)
Good things about nurses
7.15 Children and young people had lots of positive things to say about nurses. Nurses were generally seen as more friendly and approachable than doctors ('overall I liked the nurses better than the doctors' Amy, 8). There were many occasions cited where a nurse was described as making the hospital experience better for the child.
The things the children and young people reported they liked about nurses were:
The gifts they gave (Alex, 9 said he got a scarf from a nurse which was good)
They way they speak, they're nice (Eli, 15)
They're friendly (Amanda, 15)
They speak to you like they care (Helen, 15)
Because they give us sweets…there was a whole bag of them, we got to choose (Tiandra, 6)
The nurses were really nice when I was in hospital, they were just really nice and jolly I like that, and they let me call them by their names and they were really funny, they were really nice. (Amy, 8)
They say nice things like 'sweetheart' to you (Emily, 8)
They talk to you nice (Amy, 8)
7.16 There was also something about consistency of care. Amy (8) liked it when she came back after her stay in high dependency and the same 'nice nurses' were on the ward. Amy (8) also had a useful insight about liking nurses better than doctors. She said that she 'liked them better' but that 'they weren't better but I liked them better' realising that the nurses weren't necessarily better in all ways than the doctors, but they were more likable. She liked the role of the nurse better, as it offered her comfort, and talked of the things the nurses did that made her feel better :
They offer you things that takes your mind off things but doctor's don't suggest things, nurses usually suggest nice things like some toast or whether you want to go into the playroom (Amy, 8)
She also preferred the way they explained things.
I like it when the doctors tell the nurses because the nurses are better at saying it, the nurses have a nice way of saying it (Amy, 8)
Emily, 8, also liked nurses better than doctors because of the way you can be more familiar with them when speaking to them
Nurses say like sweetheart and stuff like than and doctors say just like your name (Emily, 8)
Not so good things about nurses
7.17 The children and young people had less to say about the things they didn't like about nurses. The only negative comments specific to nurses were that some of them weren't as friendly as others.
Some of the nurses were not smiley (Tiandra, 6)
There was one nurse that wasn't smiley and then you feel like really scared and then she takes you by the arm…there was one nurse I didn't like very much, she didn't smile (Amy, 8)
7.18 Auden (10) made a particularly astute observation about the nurses on the ward during one of his stays in hospital. He said he felt that 'hospital was not so good depending on the mood the people were in'. He described asking the nurses to do things for him and how their lack of enthusiasm didn't make him feel good.
You ask for something to be done em they just they ah they did actually do it but it they just like seem, it's like if they weren't in a good mood you would ask them to do it and they'd be like 'oh right' and I mean they wouldn't be like 'okay I'll do that for you no problem' and that…some nurses in the hospital some nurses can be like if you ask for something, like a drink of water, some nurses will be like 'okay I'll get you one' and then some nurses can be 'och all right' [makes funny face] (Auden, 10)
For Auden, it wasn't simply enough for the nurses to go through the motions and the mood the nurses were in had an impact on his experience of staying in hospital.
The Dentist
7.19 Several children and young people made reference to their dentist, more commonly the older teenagers. For younger children, the focus of discussion about the dentist was on the waiting room and the process of waiting (as previously described), although one commented disliking injections and another on disliking the smell of rubber gloves. A younger child reported liking the choice of stickers at her dentist, who had ' lots of good ones' (Stuart, 8).
7.20 Several of the older teenagers described a good relationship with their dentist. Two girls (both 15) described an arrangement they had with the dentist that if they put up their hand the dentist would ' stop straight away until you're feeling better'. This helped them feel in control. The same girls also appreciated the way the dentist treated them in an age-appropriate way and explained things.
I like my dentist, she's ace, she speaks to me like a grown up (Claire, 15)
And they tell you what they're going to do, they don't just like do it, they tell you each step what they're going to do (Laura, 15)
7.21 Another young person described liking her dentist because she'd known him 'for years and years', and another because he was 'nice' to her. The stickers were also mentioned as a positive aspect of going to the dentist by one teenager.
7.22 The young people reported disliking several things about the dentist. These were: the treatment, getting injections and the smell. Having to have injections was the most prominent concern.
The Orthotist
7.23 Several children and young people, who consulted an orthotist to have splints cast and fitted, made negative comments about this process. Some felt it was ' boring', while others felt that the process of being cast for splints didn't ' feel nice', was ' sore', or was uncomfortable. One child enjoyed the process of getting his splints cast and fitted. He thought it was fun and liked his orthotist ( 'the guy who does my splints is very good' Auden, 10). There was common consensus among one group of disabled children that there were not enough designs to choose from. Children reported wanting more plain colours to choose from as well as ' something good like more designs' rather than just plain white.
7.24 One child (Lily, 8), who wore a spinal brace, named the room she was cast for her brace as her 'worst room' in the hospital. She did, however, like ' getting to choose a lolly' at the end of the consultation.
The Physiotherapist
7.25 A few of the disabled children and young people also made reference to seeing their 'physio'. One young person felt he didn't get enough physio, and two children felt that 'physio was annoying' because sometimes you had to have physio at school instead of doing something else that you enjoyed. One girl (13) said she liked it that she was friends with her physio.
Confidentiality
7.26 The young people in the groups that consisted only of people aged 15 or over were asked specifically about confidentiality. All of the young people, who were asked, were concerned about confidentiality when visiting their GP. Even when the GP had spoken to them about keeping things confidential, they still worried the doctor would tell other people about their consultation.
They say it gets kept confidential it probably would be but I just worry that they would tell folk (Laura, 15)
Same here they can tell other people (Claire, 15)
And then the whole world knows all your business (Laura, 15)
7.27 Some of the young people appeared to be aware of some of the child protection guidelines about confidentiality and were also concerned by their doctor being the doctor for the whole family and so may share information with other members of the family.
Do you ever worry about confidentiality in other settings like at the GP? (3 young people respond with 'yeah') ( NC)
They'll go and grass on you to your mum (Amanda, 15)
Yeah (Helen, 15)
Do you think there's a chance that they might tell your mum?( DC)
Yeah (Amanda,15)
Yeah they willnae keep it (Charlotte,15)
Yeah cause it's a family doctor (Helen, 15)
Yeah they say they will (Amanda,15)
But then if they think you're in danger or whatever then they'll tell (Eli, 15)
But family planning just keep it to themselves (Charlotte, 15)
7.28 While it was felt that the GP possibly wouldn't keep things confidential, all these young people felt that the family planning clinic offered complete confidentiality and had trust in this confidentiality. This was cited as a reason for going to the clinic (alongside not having to make an appointment and being treated well). It was felt that 'your mum doesn't have to know that you go there'. Even if the young people had been promised by their doctor, they still had concerns about confidentiality ( 'sometimes they say it's private and confidential but sometimes you still get nervous'). Similar concerns were also voiced about asking a pharmacist for advice.
What might put you off asking a pharmacist for advice about something? ( NC)
I dinnae ken they could go and tell folk (Laura,15)
Summary
7.29 When describing what is good and bad about different health care professionals, the children and young people the importance of communication and being friendly - this was manifested in a sense of humour, being polite and giving your things. However, they also talked about doctors as being healers. Sometimes they described what doctors did as unpleasant, but otherwise it was not being friendly that was cited as making a 'bad' doctor. The children and young people often drew on personal experience to illustrate both the positive and negative aspects of relationships with health care professionals. The children and young people said many positive things about nurses, who were often described as friendly and approachable; this was illustrated through the expression of physical and emotional comforts. Those with experience of other health professionals reiterated similar sentiments and also described some unique features such as feeling in control of intervention at the dentist, experiencing discomfort at the orthotist. The young people also talked about concerns over confidentiality, even though they had been reassured by the GP.
7.30 The following chapter presents the remaining findings under the two further domains identified in the analysis: the emotional impact of accessing health care and involvement in decisions and control over choices.