Knowing Your Patient

Infants

Infants are children during the earliest periods of life. They are afraid of two things, falling and loud noises. Safe, gentle handling of the infant while in your care is the first concern. If it is true, as some think, that an individual decides within the first 10 days of life whether he or she likes this world, you would not want your treatment of a newborn to influence this negatively. Although hard evidence for this belief may be difficult to find, gentle handling of a newborn is always in order. You will be interacting with some infants who have to go through a great deal of painful treatments in the first few days of life (Fig. 12-1).

On the first day of an infant’s life, he or she can do many things. Importantly, these activities have not been learned; rather, they are reflexes that require no thought and cannot be controlled by will. The grasping reflex can be observed by placing your finger in the palm of the infant’s hand. He or she will instantly grasp it tightly with an amazing amount of strength. The infant can stretch, squirm, arch the back, kick, and vigorously wave the arms. These actions are clues that the nerves and muscles are developing normally.

An infant’s facial expression is his or her way of communication. Infants need to be held securely and spoken to in a low, soothing voice. A crying, agitated infant will often calm down when wrapped tightly in a blanket and spoken to in a soft, soothing voice. The parent or adult who accompanies the infant can often be a great help in calming the infant and in assisting during the examination.

The first order of safety is preventing physical harm and preventing unwanted exposure or overexposure to radiation. Radiation exposure is more critical to infants than to individuals in any other age group. This is the time to be reminded of the Law of Bergonie and Tribondeau, which is based on the sensitivity of cells to ionization radiation. The law states that cells are most sensitive to the effects of ionization radiation when they are rapidly dividing. This is important to remember because the most rapid growth period in an individual’s life is during infancy. Cells are dividing very rapidly thus the infant is most likely to be affected by radiation.* When radiographing infants, using radiation protection devices and irradiating only the anatomic part in question are critically important.

Children (1 to 3 Years)

By the time children are 3 years of age, a sense of right and wrong has begun to develop (Fig. 12-2). They have some concept of property and know what belongs to them and what belongs to others. If discipline has been consistent, they will begin to behave in a socially acceptable manner. The behavior may not always be consistent, but children will know the difference between right and wrong. Their reasoning ability may not be developed at this time; that is, they may not know why certain acts are not socially acceptable. In other words, they do not always seem to know what is acceptable and what is not.

They can speak, make sentences, and can follow instructions. However, they may choose not to do so, which is often the case. The parent or adult who is accompanying a child will be helpful with this age group as they are with infants. If a child in this age group has had a previously painful experience in a hospital or medical facility, the memory of that experience may evoke a negative response. The parent will be helpful in calming or restraining the child if needed. If time permits, interacting with the child and gaining his or her trust are laudable goals, but the parent will probably be more successful than you.

Children (3 to 12 Years)

During this wide span of growth years, the child’s development includes the concept of self (Fig. 12-3). This group has been out in a world that must seem big and confusing. They have new associates; school brings them in contact with others who are not family. Their names become important because this makes them a unit separate from the others. Love and esteem become very important to this age group. The teachers of this group recognize this concept and award tokens (e.g., gold stars) frequently and liberally to students who accomplish their assigned tasks. This age group has integrated into society and has become socialized as they interact with others in school. Normally, they will have learned to postpone instant gratification for the promise of future gain. This big step indicates that they have developed a concept of time. Communication with this age group should not be a problem. In examinations during which some pain is involved, this age group can normally tolerate some pain knowing that what hurts now will be made well later.

Before leaving the discussion on the interaction with children, it should be mentioned that you will have a special responsibility when examining traumatized or otherwise abused children, especially infants. You may encounter children who have been physically or sexually abused or merely abused because of neglect. In such cases, you should know what is legally required of you. All states have laws regarding who should report abuse, but states differ on these laws. Some states require that anyone who knows of child abuse must report it to proper authorities; other states list specific health care professionals as the recipients of reports of child abuse. It is incumbent on the health care provider to know the requirements in his or her state and to recognize injuries that are not consistent with the explanation given as the cause of the injury.

Adolescents

The teenage years are expected to be intense and troubling for both the parents and the teenager (Fig. 12-4). All training during early childhood has been aimed at making the individual capable of being independent. Adolescents want to be independent but do not yet have the skills or maturity to be so, thus they become frustrated. In addition, a major decision has to be made during this age on what they want to become as adults. This decision can be very difficult for those in this age group. There was a time when a young boy was expected to follow in his father’s footsteps and simply continue in the family business or trade. This is not so anymore. Consequently, choosing a career that is attainable can be a real dilemma for many because of the numerous options available to them.

Teenagers want identity and want to be treated as adults. In conversations with them, the adult approach will most likely generate a cooperative response. They may even volunteer information and express an interest in the imaging process or in their scheduled examination. A dominant characteristic of this age group is the close relationships they have with their peer group. In extreme cases, the peer group will have more influence over the teenager than the parents, teachers, or others in authority—sometimes with tragic consequences. Fortunately, these influences diminish in most adolescents as they mature and develop realistic goals and aspirations. As they gain maturity, they will be able to differentiate the possible from the ideal and evaluate and compare different points of view. With this ability, they will encounter and recognize the reality of human failings, which may make them critical of institutions and organizations. Generally, they will come to accept the prevailing expectations of society.

A troubling aspect in treating teenagers, in fact all children, is figuring out who has the authority to make medical decisions for them. Usually society will seek the permission of the parent or legal guardian for all medical treatment for those under 18 years of age. However, an underage child may be hurt at school and be brought to the radiology department by a school employee. Sometimes a relative—a grandmother or an older sibling—or even a fellow teenager may be the one who brings the young patient for care. Such situations present a dilemma because these individuals have no legal right to make medical decisions for the child. Instances exist in which the right of the parent to make the medical decision for their child has been questioned. Some parents whose religious beliefs cause them to reject medical help will instead leave the child’s fate in the hands of God. There is no clear cut answer here. This medical dilemma is outside the scope of this text.

Young Adults (21 to 45 Years)

The teenager, impatient to become independent, is now an adult with responsibilities and obligations not merely for his or her own welfare but also, in most individuals, for the welfare of others (Fig. 12-5). Most will have selected a partner because they have a critical need for intimacy, have started a family, have settled into a career or job, and have established a place in the community. Young adulthood is a period of productive and creative effort. However, it is also a time when problems arise as the new role of responsibility for taking care of family, financially and in other ways, becomes demanding and stressful.

In the event of a life-threatening disease, young adult patients may appear to be overly concerned about their health. Their anxiety is understandable and should be expected. A life-threatening illness at this untimely age can be devastating. They are not only concerned about their own welfare, but they may have dependents whose lives will be drastically altered without their support.

You will be able to interact with this adult group because, generally, they will be able to understand and follow instructions. Being a good listener is appropriate with this age group.

Middle Age (45 to 65 Years)

Those in this age group will have settled into sharing their lives with others (Fig. 12-6). They have developed a pattern of activity with their families and communities. Their children are becoming independent, the “empty nest syndrome” may cause them to seek a greater role in civic and community affairs, and they may travel or seek other diversions apart from family. They have a well-defined value system and associate with others with similar values. Their concerns may be in maintaining their independence and preparing for the years after retirement. Your interaction with this group will be similar to that in the previous age group.

Senior Citizens (65 Years and Older)

This country and nations all around the world are experiencing a population growth of people over 50 years of age (Fig. 12-7). The fastest growing segment of this country’s population today is people over 85 years of age. Of this segment of the population, 70% are women. Approximately 100 years ago, women died younger than men, many in childbirth. The life expectancy was only 47 years. Today, life expectancy is over 79 years.

The majority of this group will suffer from such diseases as osteoporosis, diabetes, arthritis, Alzheimer disease, cancer, and heart and vascular diseases. Despite this litany of diseases affecting the aging population, many continue to be active, productive citizens. Older people, some advanced in years, continue working. Many are volunteers, performing useful tasks; some take enrichment courses and even start new careers.

These patients need to be treated as any other adult—with dignity and respect. They will move more slowly and may require support. Many will have difficulty hearing and seeing, and communicating with these patients may be difficult. Obviously, you will have patients in this age group who are terminally ill. Some will not be able to respond to your instructions. They need to be handled gently, taking care to make them as comfortable as the examination permits. It may be necessary to call for assistance in examining patients who are unable to understand or respond to instructions. Dealing with death and dying patients is beyond the scope of this text, but it is not beyond the scope of your curriculum in radiography. Understanding the process, the emotional, physical, and personal aspects of death, is an essential component of your education.

The increased life expectancy of people today has placed the responsibility of caring for them on others. For some individuals, this added responsibility has been stressful and has resulted in elder abuse; often times by mere neglect. Elder abuse is becoming more common, and the abuse may be physical, financial, or psychologic. As with child abuse, states differ when it comes to the laws regarding elder abuse. What is different in elder abuse is that the patient must sign a patient consent form to have the abuse legally reported.

Diverse Conditions and Populations

Most of the discussions in the preceding topics have been about the average or the usual patient. However, you will encounter patients who may exhibit problems beyond the average and patients who merely require special treatment. For example, patients of a different culture who speak a different language may require special attention in your interaction with them. Your duty in situations such as these is to respect the patient’s beliefs. If language is a problem, calling for assistance in communicating to the patient may be necessary to ensure that a diagnostic examination can be performed.

Other patients who will present different problems are those who abuse alcohol or drugs, who have a communicable disease, and those who have suffered trauma. In addition, you will interact with patients undergoing treatment with catheters, tubes, orthopedic equipment, or other medical devices attached. These conditions and situations will require knowledge and skill and, in some cases, innovation. One answer will not fit all. Each case presents its own unique challenge, but every patient requires the radiographer to act in a caring manner. Remember, most patients are dealing with pain, anxiety, and fear, and your interaction with them must always be respectful, courteous, and professional.

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