Canadian Medical Association Journal 1996; 154: 135
But we agreed to publish the story because we believe it highlights some of the major problems in communication that can arise during the course of attempting to look after a sick infant.
Most important, of course, is the difficulty in predicting the course of an illness when the patient is an infant and unable to indicate exactly what is happening. Disease in infants can move with astonishing speed, especially when it involves water and electrolyte depletion. Therefore, the family and the caregivers must be extra careful in following the course of the disease and in ensuring that instructions are not only given very clearly but also fully understood by those who must carry them out.
Another difficult problem is the tendency of those who are knowledgeable about disease to become enured, even deaf, to the concerns of what they interpret to be an over- distraught parent. This is an especially easy trap in which to fall, and we have all experienced the gnawing afterthought that we may have dismissed a patient's or parent's concern too lightly.
Finally, the problems of the hierarchy of authority between the various health professions is particularly disturbing. It is easy to blame the nurse for failing to challenge the resident's decision not to start rehydration of the baby, or to blame the physician for not asking the nurse's opinion.
However great their knowledge and intentions, the biggest challenge to all health care professionals is to maintain open lines of communication, among themselves and with patients and their families. Unattended concerns and misunderstood counsel can be fatal.