Dr Colin Ball, Consultant Paediatrician and Honorary Senior Lecturer in the Department of Child Health at King’s College Hospital has been involved in the CYPHP programme for four years. We asked Dr Ball a few questions, and he offered some of his insights about working in new ways with primary care colleagues.
Could you tell us about your clinic at King’s College Hospital, and the type of conditions you treat in the children you care for?
I see children in my General Paediatric Clinic with almost any paediatric problem, particularly if there is uncertainty about the diagnosis or formulation of investigations and management.
I have been described as the “orphan-disease paediatrician” at King’s several times before. I can usually identify the right pathway once we have the correct or appropriate working diagnosis. I’ve always had an interest and commitment to psycho-social aspects of paediatrics and have worked closely with agencies such as Child and Family Psychiatry to help children and their families.
The supportive role of the GP in all of this is absolutely crucial, and joined-up working between primary and secondary care makes all the difference.
Among the children and young people you currently see, do any of them have conditions that could be managed directly by them or their parents/carers?
It’s important not to over-medicalise issues, and for example to use prescriptions with care. Dietary changes, for example, can help a great deal, and adjustments to lifestyle can be transformative. Most of all, I always hope that patients will feel better after I’ve seen them. I want them to be able to appreciate progress that they have already made, and to believe in themselves.
Everybody needs encouragement, including parents. I try to always talk to parents and the child. It can be surprising how much useful information this will generate, and even highlight ways forward that have not been considered. It is all too easy to present a child as if they were a list of problems rather than a window open on opportunity.
Parents, particularly mothers, often feel guilty and responsible for their child’s difficulties whatever the problem is, and the emotional aspects of looking after families should never be ignored. So, one of the things I will always try to do, is to show children and their family how they best may be able to help themselves. This is often very practical and can sometimes be supported with useful self-help resources like:
- “ERIC” for nocturnal enuresis.
- MindEd resources, which help to recognise and connect aspects of body and mind in our understanding of health.
- The CYPHP resource packs could help many families find solutions to common problems like asthma and constipation.
Of course, supporting children in the context of their parents and families is something that GPs do all the time.
How are Paediatricians and GPs working more closely together for children?
Most GPs look after children very well without paediatricians being involved. But what we’re learning in CYPHP is that having the opportunity to discuss a child using the telephone hotline, and/or to see a child together through In-reach clinics, all helps us to provide real-time support to each other and importantly better care for children. Learning is a two-way process; we all learn from each other and are stronger working together.
An important challenge that my General Practice colleagues face is the limited amount of time available for consultation. This is one reason why team-working and practical support and resources are important. For example, the “Spotting the Sick Child” video is a great support, with an illustrated approach to assessing sick children and a 3-minute checklist that aids in excluding significant clinical problems. You can access “Spotting the Sick Child” through this link.
GPs and Paediatricians share our dedication to providing excellent care for children, and by combining our pragmatic approaches to care and sharing expertise, we are building strong teams and providing better care for children and families.
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