The ultimate goal of a Pediatric post-graduate curriculum is the
creation of doctors capable of successfully dealing with child health
problems. By the end of training, everyone can state the ABCD of
resuscitation, but very few have heard of the ABCD of pediatric
practice. This stands for Appearance (A), Behavior (B), Competence (C)
and Drama (D)! They are core competencies required for impressing
parents and dealing with them artfully. The effect of mastering them is
directly proportionate to professional success. Regretfully, their
importance has not been recognized by academicians and curriculum
planners. Practical awareness dawns on most pediatricians gradually over
the years – by learning from personal experience and observing more
successful colleagues.
A, B, C, and D (in descending order of importance)
are essential for laying the foundation of the doctor-parent bond. They
empower a pediatrician by enabling him/her to impress parents resulting
in continuous follow-up from infancy to adolescence (and sometimes even
the next generation!). Building the relationship begins with the doctor
appealing positively to the parent (dependent mostly on A and a little
on D). It is further nurtured primarily by positive behavior, and
secondarily by competence. Each component will be discussed briefly in
the following paragraphs.
Appearance
This comprises of attire and demeanor of the
pediatrician as well as how appealing and comfortable the décor of the
establishment is. Attire can be formal, semi-formal or casual and is
gender-specific (Table I). In Government hospitals, formal
attire is mainly adopted by senior faculty or is occasion-based
(lectures, paper presentations, conferences, examinations). Semi-formals
are worn usually by junior faculty except in the afore-mentioned
instances. Casuals are worn by residents to cope up with strenuous 24
hour duties, and also because of lack of laundry services in most
hostels. This is acceptable as long as social norms are respected (no
unwarranted body exposure) but is generally frowned upon afterwards.
Women in government hospitals should opt for minimal make-up, less
expensive clothes, subtler jewellery and flat heels. This helps in
establishing rapport with the disadvantaged populations they serve as
there is no obvious disparity in circumstances. Ill-conducive working
environments (mud, dust or waterlogged areas that need to be waded
through or jumped over) also dictate one’s decision. In contrast, formal
attire is worn by almost everyone in private hospitals due to the strict
dress codes (ties even in summers for men!) and much cleaner
surroundings. Here, it is important to appear financially successful and
at-par with the clientele to instill confidence and faith in them.
TABLE I Description and Levels of Appearance, Behavior, Competence and Drama
Appearance (attire) |
Behavior |
Competence |
Drama |
Female |
Male |
Levels of composure, |
Parental satisfaction |
Ability to over exaggerate, |
|
|
patience and politeness |
levels with treatment |
convince and bluff parents |
|
|
in
trying circumstances |
and
care |
|
Formal |
Formal |
Level 1 |
Level 1 |
Level 1 |
Sari, Salwar |
Suits with |
complete composure, |
Satisfied |
Parent impressed and |
Kameez, Formal |
ties, shirts, |
maintaining patience and |
|
awestruck |
Western suits |
pants |
remaining polite |
|
|
Semi-formal |
Semi-formal |
Level 2 |
Level 2 |
Level 2 |
Salwar Kameez, |
shirts, pants |
Slightly ruffled, slightly |
Neither level 1 or 3 |
Neither level 1 or 3 |
trousers, tops |
|
impatient and occasionally |
|
|
|
|
becoming impolite |
|
|
Casual |
Casual |
Level 3 |
Level 3 |
Level 3 |
Salwar Kameez, |
T
shirts, jeans |
completely ruffled, loses |
Dissatisfied |
Parent unimpressed and |
kurtis, T shirts, |
|
patience completely and |
|
not
awestruck |
jeans |
|
rude
or aggressive |
|
|
Behavior
This encompasses facial expressions and body language
(pleasant and positive), approachability (more for juniors and slightly
less for seniors) and ability to respond appropriately in stressful
circumstances. These range from brawls, physical altercations, hostile
family members, extremely high expectations of attendants, and having to
answer questions based on information that is anecdotal or
internet-derived. Levels of competency also differ according to setting
and seniority. Least desirable behavior is exhibited mostly by residents
of government hospitals. This is understandable due to associated
environmental (low doctor-patient ratios, more critical patients, more
apprehensive family members and barely existent security) and
psycho-social (lower patient educational levels and hence understanding)
factors. Residents of private hospitals perform better due to mandatory
Personal-Relationship orientation programs, less stressful situations
and better working conditions. Government hospital faculty and
consultants of private hospitals are not exposed to such situations, as
frequently, as their juniors tend to serve as shields. However, when
they do, they are better at defusing the tension due to the ability to
remain calm and polite, and due to the intrinsic aura associated with
their designation!
Competence
Contrary to popular misconception, this component is
not dependent on how much you know or can do, but rather on personal
outpatient attendance and admission rates. An indirect indicator is also
the ability to induce high levels of parental satisfaction. In private
hospitals, parental satisfaction is considered sacrosanct as it ensures
more visits, wider recognition, increased clientele and financial
returns. Despite having to pay exorbitantly for services, parents are
more satisfied with the level of care due to better standards of
comfort, cleanliness, cafeterias with branded outlets and lack of
overcrowding. Satisfaction with treatment is also higher as cure is
usually inevitable and mortality unlikely, given the relative stability
of patients. In contrast, patients frequenting government hospitals are
more disgruntled due to the long queues and lack of facilities and
comfort. They are usually not appeased with explanations doled out for
not medicating (e.g. diarrhea will improve with only ORS and
antibiotics are not required in a cold). However patient satisfaction
does not really matter as there is no dearth of patients, no monetary
loss if patients defect and salaries remain unchanged. Competence of
government hospital faculty is judged by numbers too but the parameters
differ. ‘Numbers’ here refer to numbers of conferences attended,
international papers presented, papers published, committees one is a
member of, and visits to the head of the institute’s office or Ministry.
Drama
This includes the ability to: over-exaggerate
seriousness of illness (a cure means you have saved the patient from
death!), convince parents for admission (when domiciliary management
would have sufficed) and use actually simple, but apparently
sophisticated, equipment in such a way that it appears awe-inspiring and
fear- inducing. A few pediatricians are actually naïve enough to object
to this on moral grounds. However, even they can still be successful by
over-compensating with A, B and C.
To conclude, I have attempted to present theory in a
structured way so that related psychomotor and communication skills can
be developed by the readers so that they can achieve success. I strongly
urge concerned authorities to incorporate this topic into the pediatric
curriculum. Apart from benefiting the trainee, it would also ultimately
serve the community. Successful pediatricians mean better child health,
happier parents, and a more prosperous nation!