Abstract
The paediatric patient is considered to be a child. However, when it comes to communication with a patient, his consent, implementation of appointments, then the party of interaction is supposed to be an adult. In this regard, the paediatric patient is represented by a child-adult alliance, which allows us to speak of a ‘complex patient’. At the same time, his personal agency (the ability to independently formulate a complaint, accept appointments and achieve compliance) changes with the age of a child, coming to him from an adult. This determines the efficacy of screening as well as the main tactics of interaction between the doctor and the patient, explanation, and compliance. Based on the theory of periodization of the personality development, answers are given to the questions: who, a child or an adult, formulates a complaint, who accepts the explanation and who is the subject to compliance? It has been shown that in early childhood (up to 3 years) the patient's subjectivity in the formulation of a complaint and a picture of the disease, the perception of prescriptions and adherence to compliance is provided by the parent. During the pre-school (3–7 years) and primary school (7–11 years) periods, the picture is mosaic: the doctor compares the opinion of the parent and his child to get a picture of the disease, he gives prescriptions to the parent and/or to the child, so both of them can be a subject to compliance. And only in adolescence (12–17 years) a child can be almost a completely independent subject in all aspects of interaction in the doctor-patient system.
Highlights
ВВЕДЕНИЕ Отношения врача и пациента всегда стояли в центре внимания медицинской науки, которая описывает четыре модели взаимодействия врача и пациента: инженерную, патерналистскую, коллегиальную и контрактную [1, 2]
The paediatric patient is represented by a child-adult alliance, which allows us to speak of a ‘complex patient’
His personal agency changes with the age of a child, coming to him from an adult. This determines the efficacy of screening as well as the main tactics of interaction between the doctor and the patient, explanation, and compliance
Summary
Что в раннем детстве (до 3 лет) субъектность пациента в формулировании жалобы и картины болезни, восприятии назначений и соблюдении комплаенса обеспечивается родителем. ПРОБЛЕМЫ СУБЪЕКТНОСТИ РЕБЕНКА В КОМПЛЕКСНОМ ПАЦИЕНТЕ В литературе практически не обсуждаются особенности взаимоотношения врача с ребенком без родителя, а также комплаенса с пациентом в педиатрии [11, 12], поскольку чаще всего предписания и назначения врач адресует родителю, полагая, что ребенок еще не в состоянии понять и выполнять предписания самостоятельно. Следуя содержанию понятия субъектности пациента, мы полагаем существование четырех ситуаций во взаимодействии врача с комплексным пациентом в разные возрастные периоды ребенка, когда его состоятельность и участие проявляются по-разному при решении основных задач медицинской консультации: 1) выяснение жалобы (запрос на консультацию); 2) выяснение картины болезни (постановка диагноза); 3) сообщение пациенту разъяснений о заболевании и лечении; 4) формирование комплаенса (формирование у пациента приверженности лечению, мотивированного и ответственного соблюдения назначений). Age periodization of the child’s development and subjectivity of the complex patient
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