Пациент в педиатрии: ребенок, взрослый или оба?

Abstract

The paediatric patient is considered to be a child. However, when it comes to communication with a patient, his consent, implementation of appointments,  then the party of interaction is supposed to be an adult. In this regard, the paediatric patient is represented  by a child-adult alliance, which allows us to speak of a ‘complex patient’. At the same time, his personal agency (the ability to independently formulate a complaint, accept appointments  and achieve compliance) changes with the age of a child, coming to him from an adult. This determines the efficacy of screening as well as the main tactics of interaction between the doctor and the patient, explanation, and compliance. Based on the theory of periodization of the personality development, answers are given to the questions: who, a child or an adult, formulates a complaint, who accepts the explanation and who is the subject to compliance? It has been shown that in early childhood (up to 3 years) the patient's subjectivity in the formulation of a complaint and a picture of the disease, the perception of prescriptions  and  adherence  to compliance  is provided  by the parent.  During  the pre-school  (3–7  years)  and  primary  school (7–11 years) periods, the picture is mosaic: the doctor compares the opinion of the parent and his child to get a picture of the disease, he gives prescriptions  to the parent and/or to the child, so both of them can be a subject to compliance. And only in adolescence (12–17 years) a child can be almost a completely independent subject in all aspects of interaction in the doctor-patient  system.