Image of doctor kindly accepted from FreeDigitalPhotos.net contributed by ambro
You’ve probably been there…
The doctor asks if your child’s asthma has been ‘good’ or ‘bad’. Or if there ears have been ‘bad’, or there eczema has been ‘good’ – it kinda makes you feel judged doesn’t it?
And not just you, your child too. It doesn’t seem quite so bad when it’s a symptom which appears to be out of an individual’s control like ear infections, but what about long-term conditions that we do try to control – aren’t using ‘good’ and ‘bad’ much more judgemental? It implies that parents have failed to control it – even though for asthma for example is triggered by temperature changes or colds for example.
Doctors should just pack it in then shouldn’t they? After all, nobody chooses to have asthma or eczema.
I agree, and I’ve certainly become much more conscious of this and make great efforts to avoid this. Tell you what though, it’s not easy. Particularly when parents themselves use these terms. I tend to say things like ‘has your asthma been playing up for you?’ – anything that doesn’t imply that the child is in any way responsible for the symptom.
This is particularly important in diseases where ongoing treatment is required to control them like diabetes and cystic fibrosis – even hints at these sorts of value judgements over time affects the doctor-family relationship. Often (particularly in teenage years when rebellion is already common) it leaves patients dreading appointments.
Is it ever useful?
I’d be inclined to argue ‘no’ but certainly in some conditions such as eczema it often is that parents have struggled to keep up with moisturisers that causes flare-ups. Often this is due to other pressures, but the only solution is to push on with these measures so parents are responsible and this should be emphasised.
Can we do anything to avoid this?
Certainly it feels wrong to make these value judgements, but another factor is that families (and where possible the child) should be an equal partner in the ongoing treatment. If they negotiate and ‘own’ the plan in partnership then the progress is a shared responsibility.
Next time you hear this, remember your doctor is probably completely oblivious and try to remember it’s very unlikely to be any actual form of judgement but more habit and convenience.