Reassurance
fever, ’, constipation, cognitive and affective, irritable bowel
SAID, IRRITABLE BOWEL
Parents expressed to feel reassured via two different pathways; cognitive and affective reassurance. Cognitive reassurance was achieved when the GP responded to or changed their beliefs about the symptoms (their cognitions). Whether the GP provided an explanatory model for the symptoms, and the choice of model, played prominent roles in achieving cognitive reassurance. Sometimes the GP gave an explanation that matched the parents’ belief system (eg, the GP confirmed their expectation that constipation caused the symptoms), making it relatively easy to establish cognitive reassurance. However, if their child’s symptoms did not conform to the explanatory model, parents experienced insecurity about the explanation for the symptoms.Father (F5): ‘That is the weird part because you know that the laxatives are for the constipation, but if a child suddenly has a fever and lies on the couch while having a hard time breathing… and has recovered within one hour… you do not think it is constipation … but … we did not know whether to call the GP again.’How the GP conveyed the explanatory model also had a considerable impact on cognitive reassurance.Child (Ch7): ‘I don’t know … it did feel like a bit of an oversimplification. Like … it felt like she did not know the answer herself… [so] she called it irritable bowel… that is how it felt.’This was especially the case for the two children, who both expressed that they did not understand the explanations because ‘the GP talked too much’ and ‘used too many difficult words’.Some parents emphasised that positive findings during physical examination or successful treatment made them believe in a certain explanatory model.Mother (M4): ‘Yes, I think [the GP’s final diagnosis was heartburn], although this was not said definitively … [but] since we put the bed up based on their advice,… I assume that it is related to heartburn.’Other parents expressed that they wanted the GP to perform more medical tests to find an explanatory model for the symptoms. However, none of the parents mentioned to feel reassured by a normal test result.Not all parents wanted a specific explanatory model for the symptoms. Several stated that they just followed the GP’s instructions (eg, to take laxatives and return after 2 weeks with an update) and were comfortable that the GP had not provided a specific explanatory model early in the diagnostic process. In these cases, affective reassurance played a larger role, meaning parents felt reassured because the GP gave them the feeling there was no need to worry and they felt heard and understood by the GP.Father (F14): ‘She took both questions seriously … as well as our suggestions … and she found those suggestions plausible. So, she first performed a physical examination, looked at his tummy, knocked on it and she concluded that it was unlikely a purely physical cause.’