The waiting room: can we make the wait worthwhile?
Most medical appointments involve spending some time in the waiting room. If, like me, you are a parent of a toddler, you have probably become quite familiar with a number of waiting rooms, especially that of your GP. Maybe you know to sit far enough from the water cooler to avoid having to mop up a flood when your toddler gets bored. Or maybe you always sit opposite the same poster, retracing its familiar pink words. Studies have shown that 82 per cent of us notice the posters in GP waiting rooms and many of us retain the information. We are more likely to remember what we have read if it is directly relevant to us, and our retention of information also increases with number of visits to the GP (making parents of infants and toddlers an attractive audience!). The best way of enhancing information retention seems to be the GP initiating a conversation on the same topic during the consultation.
Disseminating information in the waiting room has been shown to have many benefits: not only does it decrease patient dissatisfaction with the wait, but it also opens the door for patients to feel more able to start conversations with their GP, often on topics of preventative healthcare they might otherwise not mention, often because of time pressure.
Further studies have shown that clinicians think using our waiting rooms for educational purposes can only be beneficial. However, overall we lack a clear strategy. From my viewpoint, both as a junior doctor and as a parent, studies have shown almost none of the information provided is targeted at children directly.
I often feel we don’t give our toddlers and younger children enough credit for how much they understand or how much they could participate in their healthcare. Too often we do not make them part of our conversations.
I have seen a variety of healthcare professionals brilliantly engage my toddler: making him part of the consultation, giving him an understanding of what is going on, letting him ask questions and making him comfortable in an alien and scary environment. I have also experienced the opposite. A consultation was once memorably interrupted by my three year old with a loud comment: “When will the doctor ask me my name, Mummy, he’s asked you yours…” This lack of engagement is especially frustrating when having prepared for the appointment by reading a variety of books and explaining to the child all about the appointment and the process beforehand. The caregiver then leaves with a confused child asking what has been said and why they were talking about him, and the caregiver attempting to break it down into toddler-sized chunks with a fair amount of repetition and answering all those questions (“but why, Mummy?”) whilst trying to negotiate rush-hour traffic on the way home.
Surely this is the age group to make our primary target for preventative healthcare, as well as introducing the concept of self-care. It is also the age group in which to engage interest in their own healthcare. One national consultation after another tells us that children need a voice and want to be addressed directly. We need to give them the words and the knowledge to use their voice and, in my opinion, that starts with this younger age group. There are so many excellent toddler and young child-friendly resources, from board books to colouring, that cover a plethora of common conditions, healthy eating, self-care and having a doctor’s appointment. Why not use the waiting room to start integrating both the wait and our younger patients into their own healthcare journeys?
This has further benefits, as shown in a paediatric outpatient study. Children engaged in an age-appropriate activity in the waiting room are happier and more open to communication with a healthcare professional. For clinicians, starting a conversation about what a child is engaged in offers us a way in at the child’s level. This leads to much better direct communication with younger patients and less apprehension about future visits. Interestingly, this also had a beneficial effect on caregivers, as when children were engaged in activities in the waiting room they felt better able to manage the wait and to communicate with the clinician during the consultation, focusing on their child’s wellbeing rather than a quick exit-strategy.
We envisage trialling the availability of educational resources for toddlers and young children in GP waiting rooms to see whether we can start to educate, engage and help this age group by starting conversations around self-care and preventative healthcare. We are also collecting opinions on which topics to address: asthma, eczema, dental care, nutrition and exercise. So over to you, parents and clinicians: which conversations should we start?