Case Scenario: Angry Parent of a CP Child with Recurrent Infections

Summary:

This case involves managing an angry parent whose child, Dwight, has cerebral palsy and recurrent infections requiring IV antibiotics. The parent is frustrated due to multiple failed cannulation attempts and frequent hospital visits. The candidate needs to de-escalate the situation while gathering relevant medical history, explaining management, and offering appropriate support.

Key Points

Types of Angry Patients

• Angry from the start (as in this case) – Requires immediate de-escalation techniques.

• Becomes angry after receiving bad news – Requires empathetic breaking of news.

Data Gathering Deficiencies

• Missed History Points:

  • Number of IV cannulation attempts (source of frustration).

  • Full medical history (missed scoliosis diagnosis).

  • Medication details (oral vs IV formulation).

  • Allergy history (critical when prescribing antibiotics).

  • Social history (single mother, need for support).

• Incorrect Assumptions:

  • Assuming fever subsided based on parental report rather than clinical assessment.

  • Not considering scoliosis as a factor in recurrent infections.

Diagnostic Approach

1. Confirm child’s full medical history (cerebral palsy, scoliosis, recurrent infections).

2. Assess reasons for recurrent pneumonia (aspiration, scoliosis-related complications).

3. Check for previous reactions to antibiotics.

4. Review number of IV cannulation attempts and current line status.

Management

• Immediate Actions:

  • Acknowledge parent’s frustration and validate concerns.

  • Ensure experienced staff performs IV cannulation.

  • Offer numbing cream for pain reduction.

  • Explain need for IV antibiotics (better efficacy & bioavailability vs oral).

  • Reassure about alternative options if IV access fails.

• Long-term Actions:

  • Arrange physiotherapy referral (chest physiotherapy for secretion clearance).

  • Educate on aspiration prevention (upright feeding).

  • Discuss social support options (NHS assistance, caregiver support groups).

  • Arrange follow-up with senior clinician.

Communication Skills

• De-escalation Techniques:

  • Remain calm, acknowledge frustration, and show empathy.

  • Allow the parent to express concerns fully before responding.

  • Use active listening and non-verbal reassurance.

• Explanations for Parent:

  • Why IV is needed: “IV antibiotics work faster and more effectively for severe infections.”

  • Why multiple attempts were needed: “Children with CP may have difficult veins.”

  • Next steps: “We will use a numbing cream and ask our most experienced doctor to attempt the next cannulation.”

Ethical Considerations

• Parental distress: Recognizing and addressing caregiver burden.

• Informed consent: Clearly explaining treatment options.

• Avoiding misinformation: Not making assumptions about medication formulations.