v

EXPERIENCES OF PEDIATRICIANS IN HANDLING PATIENTS

A Research Paper Presented

to the Senior High School Department

Lyceum of the Philippines University - Batangas

In Partial Fulfillment

of the Requirements for the

STEM - Medical

Atienza, Peter Joseph

Enriquez, Lhance Stephene G.

Magtibay, Erick Louie

Mendoza, Jana Maria Alyana

Villajuan, Precious Noelyn

May 2019
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ACKNOWLEDGEMENT

We would like to thank our principal, Dr. Vivian A. Perez, for her support in this

research, and to Dr. Beverly T. Caiga, Director of Strategic Directions in Computing

Research (SDCR), for her neat assessment in this research, to Miss Tyron M. Amboy,

our counselor for this subject who patiently taught the purpose and studies about the

research.

We are entirely thankful for the people who became part of this research,

especially to every member of the group who are patient and who worked hard for this

research. We would also like to thank our family who supported us in our every move

and action for this research, this would not be possible of not for them, and most

especially to Almighty God for guiding us in the process of doing out research and for

giving us strength and understanding.

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DEDICATION

We dedicate our efforts that we have exerted in making this study to our beloved

university who have given us a chance to conduct the study that we have done, to our

supportive principal Dr. Vivian A. Perez, and Dr. Beverly T. Caiga (Director of Strategic

Directions in Computing Research) for the approval and assessment of our study and

we also dedicate this study to our Practical Research 1 teacher Ms. Tyron E. Amboy

who taught us the process of making a research paper and sharing her knowledge to

us, guided us all throughout the making of this study.

To our friends and families who gave us a warm support and concern through the

good and bad times.

Most importantly to our Almighty Father who always provides us the blessings

and guidance, as well as spiritual support in everything that we do.

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TABLE OF CONTENTS

TITLE PAGE I

ACKNOWLEDGEMENT ii

DEDICATION iii

TABLE OF CONTENTS iv

LIST OF TABLES v

LIST OF APPENDICES v

THE PROBLEM AND REVIEW OF LITERATURE

Introduction 1

Objectives of the Study 3

Review of Related Literature 3

Methodology 15

Results and Discussion 17

Conclusion 24

Recommendation 24

References 25

Appendices 31
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LIST OF TABLES

Table A Demographic Profile of the Respondents 17

Table 1 Problems Encountered by Pediatricians in Handling Patients 18

Table 1.1 Coping Strategies Used by Pediatricians from Problems Encountered 20

Table 1.2 Proposed Activities of Pediatricians from Problems Encountered 21

LIST OF APPENNDICES

Appendix A 31

Appendix B 32

Appendix C 33
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INTRODUCTION

A pediatrician is a medical doctor that manages the physical, behavioral, and

mental care for children from birth until the age of 18. They are trained to diagnose and

treat a broad range of child illnesses, from minor health problems such as colds and

fever to serious diseases like smallpox. They mostly have clinics instead of hospital

residences and has a nurse trained under them. As they are faced by children, they

may encounter problems with the children’s attitudes and fears of a doctor. It is a

profession that requires a lot of dedication, patience, and commitment.

The researchers aimed to explore the problems associated with pediatricians in

handling their patients considering the various factors such as psychological aspect,

and coping strategies.

One of the top performing hospital in Batangas is United Doctors of St. Camillus

De Lellis Hospital, it is a private hospital located in Diversion Road Bolbok, Batangas

City. On November 4, 2013, it formally opened its doors to the public. This hospital

offers various services such as diagnostic, medical, ancillary, and other services.

Pediatricians are doctors who manage the health of a child, including physical,

behavior, and mental health issues. They are trained to diagnose and treat childhood

illnesses, from minor health problems to serious diseases (Brennan, 2018).

Pediatrics is a discipline that deals with biological, social, and environmental

influences on the developing child and with the impact of disease and dysfunction on

development. Children differ from adults anatomically, physiologically, immunologically,

psychologically, developmentally, and metabolically (Hotaling, A. et al, 2015).

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According to Columbia University, The Department of Pediatrics is committed to

using inspired science and translational research to address the greatest threats facing

children in the 21st century, including obesity and malnutrition, diabetes, heart disease,

cancer, infectious diseases, genetic disorders, asthma, and prematurity.

The findings of the study will be of great benefit to the pediatricians, future

researchers, and other researchers. It will redound to the following entities: The results

of this study will enable pediatricians to determine the kinds of situations they will

encounter in their profession. The findings of this study will evaluate and assess how

they prepare in handling such situations, and for them to determine their own strengths

and weaknesses on the said situation. The result of the conducted study will serve as

additional information if used as a basis in future researches. The conducted study can

be used by future researchers as reference material or in their literature foundation if

they were to conduct a related study.

With the abovementioned situations, it was the general objective of the

researchers to explore the experiences of pediatricians in handling their patients. Thus,

the research findings on the objective will distinguish the implication of their

experiences.

This was mainly for the purpose of the research to determine the experiences of

pediatricians in handling their patients. The researchers' aim was to gain information on

how they handle their patients, what difficulties do they face in handling their patients,

and what coping strategies do pediatricians do in facing the difficulties of their

profession.
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OBJECTIVES OF THE STUDY

The overall objective of this phenomenological study was to describe the

experiences of pediatricians in handling patients. Specifically, it also aimed to determine

the problems encountered by pediatricians in a psychological aspect, to distinguish the

various coping strategies, and to propose activities that will help pediatricians in proper

handling of their patients

LITERATURE REVIEW

The American Academy of Pediatrics (AAP) declares that pediatricians are

“dedicated to the health of all children." To fulfill this promise, pediatricians can work

domestically and collaboratively across international borders to improve the health of

children throughout the world, regardless of the nationality, culture, language, religion,

or socioeconomic status of those children (Suchdev & Howard, 2018).

"That being said, many children are not comfortable seeing their pediatrician for

some issues like contraception, or STD screening or other issues around their health

because they feel like it's a 'baby doctor,'" she said. An adolescent-friendly practice

should have at least one exam room that's tailored more for an older child, says

pediatrician Damien Mitchell, with Forest Lane Pediatrics in Plano, Texas. His office, he

says, is not covered in balloons and teddy bears, and other than toys, children's books

and smaller tables, it resembles a regular physician's office. (Esposito, L., 2014)
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According to UNC School of Medicine (2019) , when a child needs the highest

level of care and attention for a critical illness or injury, our physicians, nurses, and

other healthcare providers have the knowledge and skill to help the child achieve the

best possible outcome. Pediatric Emergency Medicine provides the highest quality and

technologically advanced emergency medical care to ill and injured children in the

Triangle area, as well as throughout the state. This states that healthcare practitioner

provides care to patients that are either injured or in need of medical attention.

Pediatric caregivers do not need to be told that children are not little adults. They

know firsthand that the physical, physiological and developmental needs of children are

different from those of adults, and that the clinical care and treatment they receive must

be different as well. They may not be aware, however, that when it comes to the overall

patient experience, the adult-child distinction is just the beginning. It’s very stressful for

parents to see their children in pain and feel like not enough is being done to help them.

And babies can’t talk, so it’s hard for a parent to disentangle what might be actual pain

from something else. These parents need empathy and reassurance that everything

that can be done to manage their child’s pain is being done (Mahoney, D., et al., 2017).

Pediatricians are aware of the ways in handling a patient properly especially their most

common patients which is children.

The entertainment activities during the wait and the waiting time are the two

elements viewed most negatively by the children and the parents. The children tend to

evaluate certain aspects of their experience as patients more negatively, which needs to

be borne in mind in order to improve the attention provided. What is Known: • Studying

the experience of patients is a key point in patient-centered medicine. • The experience

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of the pediatric patient has been little studied to date. The experience of the children is

often inferred from that of their parents. Nevertheless, the experience of the children as

patients might be different. Overall, the experience of children and parents in the

pediatric emergency department in the study is positive. Some aspects of the

experience in emergency are poorly rated by the children, such as the waiting time, the

information provided, treatment for pain, and privacy during the visit. The experience of

the children needs to be analyzed in order to improve the areas that are rated poorly to

enrich the experience in the emergency department (Edward, 2019).

Pediatricians focus on the physical, emotional, and social health of infants,

children, adolescents, and young adults up to age 21. Because they work with so many

aspects of children's health, they're highly trained in assessing, detecting, preventing,

and managing issues that affect children. This might involve anything from treating an

ear infection to talking to parents about school or behavioral problems to seeing kids for

well-child checkups or annual exams and giving them their vaccines (Iannelli, V., 2019).

Pediatricians are doctors of children from childbirth up to the age 21. They are focused

on the physical, emotional, and social health of their patients, treating small infections

and non-lethal viruses to life-threatening diseases.

Frequently, episodes of care such as preventive clinic visits, acute care, medical

procedures, and hospitalization can be emotionally threatening and psychologically

traumatizing for pediatric patients. Children are often subject to psychological trauma,

demonstrated by anxiety, aggression, anger, and similar expressions of emotion,

because they lack control of their environment. This sense of helplessness, coupled

with fear and pain can cause children to feel powerless in healthcare settings. These
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emotional responses can delay important medical treatment, take more time to

complete and can reduce patient satisfaction. Healthcare professionals are uniquely

positioned to prevent healthcare-induced trauma and reduce healthcare-induced

anxiety.

Although the responsibility of an effective partnership between pediatric

practitioner and parent is shared, the larger part of the task falls to the clinician. A recent

policy statement was published refers to pediatric clinicians as “privileged and trusted

advocates for the well-being of children.” With privilege and trust comes the

responsibility to foster relationships with families and to fortify such relationships when

they are threatened. It is also stated that “communication and collaboration” are

principles of professionalism in pediatric practice to be upheld. In addition, the

statement says that pediatric practitioners must recognize that “patients’ families and

the health care team must work cooperatively with each other and communicate

effectively to provide the best patient care” (AAP, et al., 2017). The communication

between the pediatric practitioner and the parents largely contributes to a successful

handling of the patients, because it allows the practitioner to work more efficiently.

Related Literature

This section of the study focused on concepts provided by authorities in the

problems encountered, coping strategies and proposed activities of the pediatricians.

Problems Encountered. Pediatricians being in the medical field encounter

various problems when it comes to handling patients, especially their patients are

usually infants, children and young adults. This problem varies from patient to patient.
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This section of the study is focused on concepts provided by authorities on the

experiences of pediatricians in handling patients through parent-patient-pediatrician

relationship, physical and mental aspects. Many children who have a mental health

disorder do not receive mental health services and are seen only in primary care

settings. Perceptions of pediatricians and mental health specialists regarding the role

that pediatricians should have in diagnosing and managing children's mental health

problems have not been studied (Heneghen, A. et al., 2009).

One of the greatest challenges for every physician regarding communication

skills is represented by communicating the diagnosis of a severe condition with a poor

prognosis. Therefore, it is crucial for the patient's managements that the care-givers

understand properly all its implications. The physician must emphasize with the care-

givers, must show compassion and understanding, but he must control his emotions in

order to maintain the trust he earned. The nonverbal communication represents

probably the milestone in these situations because under these circumstances the care-

givers’ pain and sufferance are so expressed that their understanding perception is

impaired and it may seem that they do not hear anything. The diagnosis must be fully

understood in order to assess it properly. Under these circumstances the physician

must preserve his medical thinking.

On one hand, he must never give false hopes, but on the other hand, he should

not destroy all the care-givers’ hopes because in order to help the child, the care-givers

must keep their calm and think as positively as possible.

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Therefore, the alliance between the physician and the child's care-givers is very

important in every step of the clinical management. The child must also understand as

much as possible the diagnosis and the therapeutic regimen that he is about to follow.

Despite the small age, the physician must find a proper way to explain the condition to

the child. (Benson, BJ., et al., 2014) There are many challenges for every pediatrician.

One of them is their communication skills. Regardless of the small age, the doctors

must find an easier and proper way to explain the condition of their patient.

All practitioners are familiar with the concept of the "difficult" encounter with a

family. Those encounters can range from those that leave from clinicians with a slightly

uneasy feeling once the family has left the office to those in which actual disputes occur.

There are certain names on the day's schedule that make the practitioner's heart sink

and feel fatigued in advance (Korsch, B. et al., 2017).

Pediatricians and parents generally try to do what is best for children, but they do

not always agree about what that is. Mothers and fathers may disagree with each other.

Parents may disagree with pediatricians. Disagreements can arise about the goals,

nature, and value of communication with children about health information.

Disagreements can arise over the value of particular medical interventions. Some

disagreements are grounded in different religious beliefs. Some are about moral values.

Some are disagreements about ends, others about the best means to an agreed on

end. If there is an intractable disagreement and discussion has failed to resolve that

disagreement, pediatricians must decide whether to compromise their own values to

preserve a therapeutic relationship, sever that relationship, or try to override a parental

choice by referring a case to child protection authorities. Pediatricians often face

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conflicts about whether their primary loyalty is to their patient or to the patient’s parents.

The pediatrician should be familiar with the ethics behind the patient-parent-pediatrician

relationship (Lantos, J., 2015).

A major challenge for children’s and youths’ services is to develop more effective

and efficient service integration models. In the present system, pediatricians tend to

avoid asking parents about matters for which they feel inadequately trained and for

which they are not aware of patient resources, including child development, obesity,

breastfeeding, family violence, environmental health, and mental health. The system will

not respond without adequately prepared clinician–advocates who recognize and

understand these issues and their relationship to ultimate outcomes (Retzel, R., et al.,

2012).

Coping Strategies. In different professions there are different problems

encountered by such professionals, and with this problem they develop coping

strategies on how they will surpass such problem in different occasions. These coping

strategies are mechanisms or strategy to solve a problem or either makes a work

easier.

The best pediatricians have found ways to improve pediatric patient experiences

using easy-to-implement tactics. Here are a few strategies you can use to support both

your patients and their families. There are 3 strategies to improve pediatric patient

experiences. (1) Up your distraction game. Distraction is an important technique that

can decrease patient anxiety. The technique not only keeps kids busy for a

considerable amount of time, but takes their minds off everything that’s going on around
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them. (2) make satisfaction a Priority. Ensure patients and their parents return to your

practice by making their experiences positive from the moment they step through your

doors. (3) Reduce the pain of injections. There are few tactics that can reduce the pain

of injections. These are: Offer a topical anesthetic, rub the injection site and deep

breathing (Filion J., et al., 2016).

Coping in children and adults universally includes three facets, none of which are

one-dimensional: (1) active vs. avoidant; (2) internal vs. external; and (3) emotionally-

focused vs. problem-focused. Researchers found that avoidant coping is used more

during the acute phase of healthcare or hospitalization and active coping was used

more often in the recovery phase. By focusing children’s attention on a specific aspect

of medical care, they feel better equipped to recover faster than children who are

avoidant in their experience. This focus introduces internal locus of control (Lerwick,

2016).

Proposed Activities. In the field of medicines each practitioners possesses own

strategies but through the proposed activities, the strategies and skills in doing work is

enhanced. It can be in a form of seminars and trainings which allows the practitioner to

gain more skills and knowledge in their field of work.

Proposed activities imply the exercises proposed to be performed under the

unique endorsement. It is for the reasons for the Engagement Model, proposed land

and asset exercises set out in an application or suite of related applications gotten by a

provincial agencies which is spoken to in the agreement or a choice or movement

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examined by such an agency which may have adverse impacts which is liable to

commitment as generally concurred by the parties (Connor, 2013).

Related Studies

This section discussed related concepts from dissertations and theses.

According to a study done by the Academic Pediatric Association (2016),

Positive parenting influences the trajectory of a child's life-course (96 percent), that their

counseling can affect parenting skills (79 percent), and that social-emotional risk

screening is within their scope of practice (81 percent), most pediatricians (61 percent)

have not inquired about adverse childhood experiences (ACE) of parents. As of 2013,

few pediatricians asked about ACEs of children despite acknowledging their adverse

effect on habits of parenting and baby growth. Research on the finest solutions to ACE

avoidance and improvement and the advancement of family and infant resilience is

required.

According to a study entitled “A literature review of comfort in the pediatric critical

care patient” by Alcaraz (2018), a total of 1,203 journals. Finally, this literature analysis

included 59 papers that fulfilled the requirements for incorporation. Nearly all of them

were descriptive research written in English and released in Europe. The notion of

convenience has been described as the instant situation to be enhanced by getting the

three kinds of requirements (relief, ease and transcendence) addressed in four contexts

(physical, psychological, social and environmental) of experience. Only two relevant and

safe instruments have been discovered for evaluating convenience: the Comfort Scale

and the Comfort Behavior Scale. Comfort is subjective and hard to evaluate. It has four
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aspects: physical, mental, cultural and ecological. High concentrations of sound and

light are the most uncomfortable inputs. Comfort is a holistic, universal idea and a key

element of good nursing care. In this survey of the literature, I showed a patient's search

for kinds of requirements.

Balogh Z., et al. (2012) stated in a past study entitled “Patient satisfaction as an

outcome of individualized nursing care” that surgical patients reported that the care they

received was only moderately individualized overall, but individuality was taken into

account well in patients' clinical situation and decisional control over care. Patients were

satisfied with their care, mostly with the technical aspects of care and least with the

information given. There were between-country differences in patients' perceptions of

individuality in care and patient satisfaction. A positive correlation between the level of

individualized care received and patient satisfaction was found, confirming that

individualized nursing care delivery influences patients' satisfaction with care and

demonstrating that this quality of care indicator might be able to be used as a predictor

of patient satisfaction, one outcome of care. The findings of this study strengthen

previous results and further reporting the existence of a relationship and the positive

correlation between individualized care and patient satisfaction. The results can inform

administrative decisions and policy on introducing nursing approaches to care that

would increase patient satisfaction.

Delnoij D., et al. (2012) stated in a past study entitled ” Using client experiences

for quality improvement in long-term care organizations” that the long-term care

organizations that systematically incorporate client experiences into their quality system

are more active in using the CQI for quality improvement: information was disseminated
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throughout the organization, project groups pointed out quality improvement initiatives

and every worker was involved in this process. These organizations had often held a

certificate for their quality policy for some length of time. In other organizations, CQI

information was used less systematically. For instance, only the quality manager was

involved, or improvement initiatives were left to employees working in the primary

process. The actual improvement initiatives varied. For example, employees created

more individual time for clients to avoid the feeling of being rushed; other organizations

changed the food delivery to enhance food enjoyment. Although measuring client

experiences obligatory, it is not sufficient guarantee that client feedback is used for

quality improvement. Although measuring client experiences has led to various

improvement initiatives, their effectiveness remains unclear. There is need for guidance

on effective improvement of client experiences.

Chou T.A., et al. (2010) stated in a past study entitled “Nurse-perceived time

pressure and patient-perceived care quality” that the results demonstrate time pressure

among nurses reduces patient-perceived reliability, accountability, responsiveness and

assurance. The test results, however, did not indicate a significant negative association

between time pressure and patient-perceived empathy and tangibles .Time pressure

among nurses may reduce patient perception of care quality in terms of

reliability/accountability, responsiveness and assurance.

Brigette J.M., et al. (2014) stated in a past research entitled “How nurses and

their work environment affect patient experiences of the quality of care” that the nurses

mentioned essential elements that they believe would improve patient experiences of

the quality of nursing care: clinically competent nurses, collaborative working

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relationships, autonomous nursing practice, adequate staffing, and control over nursing

practice, managerial support and patient-centered culture. They also mentioned several

inhibiting factors, such as cost-effectiveness policy and transparency goals for external

accountability. Nurses feel pressured to increase productivity and report a high

administrative workload. They stated that these factors will not improve patient

experiences of the quality of nursing care. According to participants, a diverse range of

elements affect patient experiences of the quality of nursing care. They believe that

incorporating these elements into daily nursing practice would result in more positive

patient experiences. However, nurses work in a healthcare context in which they have

to reconcile cost-efficiency and accountability with their desire to provide nursing care

that is based on patient needs and preferences, and they experience a conflict between

these two approaches. Nurses must gain autonomy over their own practice in order to

improve patient experiences.

A past study entitled “The Experiences of Doctors and Nurses Communicating

with Patients in a Cancer Unit” indicated that doctors and nurses working in this

environment communicated with their patients in a predominantly professional-centered

way, in which they control the level of intimacy with patients in order to protect

themselves from emotional distress. The ways in which they control communication

minimizes, and indeed avoids, identifying and addressing the psychological care needs

of patients, as has been found in other studies. The focus of patient care was on the

more technical aspects of cancer care (Arora, et al., 2003).

According to a finding of a past study entitled “Experiences of Public Doctors of

Managing Work Difficulties and Maintaining Work Difficulties and Maintaining

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Professional Enthusiasm in Acute General Hospitals” the main difficulty is from patients

with time constraint. With different expectations from patients, plus the heavy workload,

public doctors face tremendous stress. When one is sick, be it due to physical or mental

problem, it will lead to bodily disequilibrium with emotional instability. The condition will

even be worse when the persons have to be admitted to hospital as patients for

treatment. The patient’s relatives are also anxious for their loved ones, particularly for

the dying patient where hospital will be the place for ending life. Public doctors will see

people from all walks of life with different kinds of diseases and various expectations. It

is understandable that caring for them would be difficult in acute public hospitals where

the workload is usually heavy. They have to fulfill their roles in diagnosis and treatment

within certain time limit. The stress is even higher in times of medical emergencies for

saving life. The findings in this study illustrated why public doctors find it difficult to take

care of patients’ needs, especially for young doctors who have not gained sufficient

clinical experiences (Adrian F.Y. & Andrew L.L., 2018).

METHODOLOGY

Research Design

The researchers used descriptive phenomenological design to explore the

different experience of pediatricians of St. Camillus de Lellis Hospital in handling

patients.
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According to Christensen (2017), descriptive phenomenology is widely used in

social science research as a method to explore and describe the lived experience of

individuals.

Phenomenological research is typically conducted through the use of in-depth

interviews of small samples of participants. By studying the perspectives of multiple

participants, a researcher can begin to make generalizations regarding what it is like to

experience a certain phenomenon from the perspective of those that have lived the

experience (Earle, 2010).

Subject of the Study

In this study, 3 pediatricians of St. Camillus de Lellis Hospital were selected to

participate in the process. The subject of the study was selected using the quota

sampling. These pediatricians were selected to participate in the study because they

are the one who can give relevant data that the researchers will gather. Three

pediatricians were selected because it is the average number of informants that the

researchers need to gather the data needed.

Instrument

The researchers used individual interview for them to interview each of the

respondent individually and in private, to be in particular, the semi-structured individual

interview. Wherein the researchers have prepared questions to those to be interviewed,

and given the right to ask follow-up questions. The semi-structured interview was used

because there are answers that are often vague and needs more context of the
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situation in order to be clear. The prepared questions were validated and approved

accordingly.

Data Gathering Procedure

Before collecting the desired data, the researcher formulated an introduction and

synthesized a research literature. After formulating the introduction and research

literature, the researchers prepared a letter noted by the principal requesting permission

to conduct an interview outside the campus. The interview was conducted St. Camillus

de Lellis Hospital. After the letter was approved, the researchers administered an

interview to the respondents. After the respondents answered the questions, the

researchers transcribe and interpreted the data gathered.

RESULTS AND DISCUSSION

Table A

Demographic Profile of Respondents

N=5

Domain Frequency

Age 24-26 1

27-29 1

30-32 1

Years of experience as a 1 month-1 year 2

pediatrician 2-3 years 0

4-5 years 1
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Table A shows the demographic profile of the pediatricians are located in St.

Camillus de Lellis Hospital in Batangas City, all of them differ in age. 2 out of 3

respondents has 1 month-1 year work experience as a pediatrician and the other has 4-

5 years’ work experience.

Table 1
Problems Encountered by Pediatricians in Handling Patients

Domain Significant Statement Theme

Problems Encountered “I encountered problems Relativity

when it comes to the

relatives”

“I encounter problems with Financial Problem

patients who suffer from

financial problems”

“Whenever I have Intimacy

established a bond

between my patient and

after a few weeks they die”

“I encounter problems with Non-Cooperative Patients

the cooperation of the

patient”

Table 1 show that the majority of the respondents encounter problems in

handling patients, specifically 2 out 3 respondents experience problems to the relatives

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more than the patient itself. A patient's family member can be a valuable source of

health information and can collaborate in making an accurate diagnosis and planning a

treatment strategy during the office visit. Doctors should recognize abnormal family

dynamics during the office visit and attempt to stay neutral by avoiding triangulation.

However, it is important for the doctor to keep an appropriate balance when addressing

concerns to maintain the alliance formed among physician, patient, and family member.

(Babalola, D. et al, 2011).

Majority of the respondents also experience problems in handling patients when

it comes to the cooperation of the patients in the process of medication. When it comes

to the emotional state, 2 out of 3 respondents encounter problems in handling patients

who has a financial problem. There are a handful of reasons why doctors might not

want to treat a particular patient. Some are based on the patient's behavior. Some

patients are difficult or disruptive. They become verbally abusive to staff. They may be

angry, and fairly so, due to previous experiences either with the same doctor or another

one. Some are angry in general, making for difficult or impossible communications.

Some are just unpleasant or aggressive, even if it isn't anger that causes that behavior

(Torrey, T., 2019).

The other respondent is affected mentally when there is a bond between the

patient and practitioner and the patient dies. Experts in physician wellness have

acknowledged the death of patients is an experience that almost all physicians must

confront and asserted psychological distress (among physicians) derives largely from

identification with suffering, the presence of death and the specter of failure. Given the
 20

close relationships physicians develop with patients, it is reasonable to expect that

patient deaths could affect physician stress and resilience (Whitehead, 2012).

Table 1.1
Coping Strategies Used by Pediatricians from Problems Encountered

Domain Significant Statement Theme

Coping Strategies “Well I just talk to the Proper Transmission of

relatives, explain to them Information

what we need to do, and

what we are doing. It is

basically communication”

“I take the problems as a Problem Management

lesson for me to perform

better”

“I manage my patient and Patient Management

when I cannot manage

them I refer them to other

specialist”

Table 1.1 shows that the respondents differ when it comes to the coping

strategies that they use. When it comes to proper transmission Respondent 1 talks and

explains to the relatives for the pediatricians to avoid disruption. The communication

between patient relatives and physicians is the communication between two parties,

and it requires an exchange of information, mutual support, respect and trust. The
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physicians are professionals who need to communicate with patient relatives, and solve

the communication problems (Cicekci, F. et al, 2017).

Respondent 2 says that the problems encountered serves as a lesson for the

improvement of the performance. Understanding and managing the factors contributing

to a difficult encounter will lead to a more effective and satisfactory experience for the

physician and the patient (Lorenzetti, R. et al, 2013).

On the other hand Respondent 3 manages patient on a maximum level and

refers the patients to other specialist when the practitioner cannot manage them. Good

doctors do whatever it takes to help their patients with whatever their health care needs

require. Whether that means helping them navigate the health care system by finding

specialists, or acquiring the prescriptions they need, they should be willing to provide

that support (Cskopecce, 2018).

Table 1.2
Proposed Activities of Pediatricians from Problems Encountered

Domain Significant Statement Theme

Proposed Activities “I would watch movies or Stress Management

TV series during break time

or free time”

“You should have a strong Health

foundation and you should

be healthy mentally”.

“Be passionate and have Attitude towards work

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patience in handling

patients”

Table 1.2 shows that the respondents differ in their statement about the coping

strategies that they can suggest to other pediatricians and doctors. Respondent 1 said

that every doctor has their own strategies so the strategy of the other may not work for

the other, but he spends free time watching TV series. How physicians spend their off

hours can actually increase their productivity and success at work. Choosing the correct

hobbies or activities to partake in during their free time can ensure that they are happy

and healthy both physically and mentally (Jacoby, 2017).

According to Respondent 2, having a strong foundation towards mental health is

important. Resilience is the capacity to respond to stress in a healthy way such that

goals are achieved at minimal psychological and physical cost; resilient individuals

"bounce back" after challenges while also growing stronger. Resilience is a key to

enhancing quality of care, quality of caring, and sustainability of the health care

workforce (Epstein, R.M. and Krasner, M.S., 2013)

While Respondent 3 stated that patience and passion is always a virtue towards

work. Passion as a personal resource protects individuals from the negative effects of

stress because it enables them to attach direction and meaning to their work. Without

such commitment, a valuable source of protection from stress and its consequences

would not be available," according to psychologists who study these issues. "Passion is

therefore a crucial resource that enables individuals to resist the effects of stress and

strain in their organizational environments” (Murphy, 2018)

 23

Summary of Findings

In summary the respondents encountered various problems handling patients

such as relativity, cooperation and financial. This affects the efficiency of their service in

a positive and negative manner. It gives the pediatricians distraction in the process of

medication and it makes more room of error. But it also serves as a challenge and a

motivation for them to perform better. Based from the results, the pediatricians

specifically encounter problems when it comes to the relative of the patient, non-

cooperative patients, intimacy, and patients who has a financial problem. The results

also show that the pediatricians cope up with the problems encountered using coping

strategies including proper transmission of information, patient management and

problem management. In addition to this their proposed activities to other medical

professional who also experiences the same problems are to manage stress by taking a

break, maintaining a healthy mind and body and having a positive attitude towards

work.

This study had achieved its objectives by describing the experiences of

pediatricians in handling patient, by determining the problems encountered by

pediatricians in a psychological aspect, by distinguishing the various coping strategies,

and by proposing activities that will help pediatricians in proper handling of their

patients. The results of the phenomenological study has a connection to the medical

field and can serve as a guide to pediatricians on how to properly handle patients and

the problems they may encounter in their field.

 24

CONCLUSION

Based on the findings of the study, the following conclusions were drawn:

 Each one of the informants with a range of 6 months to 4 years of working

experience had mentioned experiencing problems in their work areas.

 Each one of the informants had encountered problems or difficulties in handling

patients.

 The common problem encountered is with the patient’s relatives and the patient’s

cooperation in regards to following medical procedures and giving out medical

history.

 2 out of 3 informants claimed that the problem affecting their emotional state is

when patients are delayed into receiving health care due to financial problems.

 All of the informants claimed to experience different problems that affect their

mental state.

 Each of the informants addressed different solutions to the problems they had

encountered but said that it is applicable to all or any problems.

RECOMMENDATION

 Establish a healthy and clear Doctor-Patient relationship in order for the whole

process to be as smooth as it can get.

 Remember to talk to your patients and their guardians to get more medical

information and background to suit a more appropriate and comforting health

 25

process. Suggest an alternative if ever the patient or the guardian is not

comfortable with the medical procedures.

 Always be cooperative and communicate to them what is currently happening to

ease out the fear and anxiety in order to relax and trust the doctor in the

procedure.

 Proceed to refer the patient to a doctor more suited for the operation or process

when you can no longer manage the patient.

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 31

Appendix A
 32

Appendix B

Rapport Questions

1. What is your name? (Optional)

2. How old are you?

3. How long have you been working as a pediatrician?

Problems Encountered

1. Do you encounter problems in handling patients?

2. What are the problems you encounter in handling patients that affects you

emotional state?

3. What are the problems you encounter in handling patients that affects you mental

state?

Coping Strategies

1. How do you handle the problems that you encountered?

Propose Activities

2. What activities or coping strategies can you suggest to other pediatricians who

experience the same problems?

 33

Appendix C

Preliminary Questions Original statement

1. What is your name? Respondent 1: I am Mark Arnel Marquez.

Respondent 2: My name is Perwigi Guliab.

Respondent 3: I’m Doctor Mark

Sandoval.
2. How old are you?
Respondent 1: I am thirty years old.

Respondent 2: Twenty six years old.

Respondent 3: Twenty eight

3. How long have you been working as a Respondent 1: I have been working as a
pediatrician? doctor for four years now

Respondent 2: Since, uhmm... My first

exposure is 2 years ago. But as working
independently so, is uhmm... 1 year.

Respondent 3: Uhmm… 6 months.

Problems encountered Original statement

1. Do you encounter problem in handling
patients?
Respondent 1: Uh, handling patients
actually is a difficult task because uh, there
are difficult patients, difficult relatives,
when I say difficult patients, I mean
patients who don’t cooperate so much
especially in terms of giving history
because uh, it is through history that we
manage patients

Respondent 2: Of course. It's alot. uhm.

Actually more than a patient is the
relatives. Kasi sila yung may... Sila yung
conscious. ahh. And then. After that the
patients of course yung physiologic needs
niya kailangan mong maattend pero yung
emotional needs din niya is kailangan
mong maiaddress, and for pedr...for

2. What are the problems that you
encounter in handling patients that affects
your emotional state?
34
pediatric patient syempre nervous ang
parents diba? So kailangan ko din
maexplain lalo. Kasi yung parents sila
yung nagrereact rather than the patient.
Okay?
Respondent 3: Depende, oo. Uhhh,
usually ang most common na…kung pedia
patients, ang most ang most common
problem natin is yung paghandle mismo
doon sa uhm, patients in this age group.
Oh so, pag ganito kasi hindi lahat sila is,
uhm, anong tawag dito? Cooperative,
ano? Yung iba ang hirap imanage, ano?
Kaya nagre-rely tayo sa input ng parents
pag dating doon.
Respondent 1: I think I would say uh,
again can you repeat the question? I think
I’ve answered it already, in terms of giving
the history also there are relatives who
would storm in emergency room and uh it
gives us a challenge in managing patients
Respondent 2: Weeell sakin. uhm…In this
time? More than the physiologic need
atsaka is the emo…ahh emotional and
financial problem. Yon. practicalistic e
diba? uhm…financial, financial problems
talaga eh. I mean. Let's be practical mas
madaling gumalaw pag may pera ka.
Respondent 3: Emotional state usually
yung mga patients na, kailangan ba yung
dito lang sa hospital na to, or kahit sa
previous experiences? Experiences, okay.
Ano ulit tanong? Usually yung mga
patients na walang pera, ano? Yung
darating sa iyo na medyo malubha na
yung kalagayan tapos di niyo magawang
magalit kasi alam niyong wala silang pera
and hindi nila agad madala sa hospital
yung mga anak nila, and then darating sa
inyo na sobrang panget,
ano?...Dumarating sa point na mamatay
yung patients, ano, dahil hindi kaagad

3. What are the problems that you
encounter in handling patients that affects
your mental state?
Coping Strategies
1. How do you handle the problems that
you encountered?
35
nadala sa hospital. Nakakalungkot, ano,
I’ve seen a lot of patients na dying
because of that, ano? And, wala tayong
magawa para doon.
Respondent 1: When it comes to my
mental state, when you have many
relatives inside the emergency room, it
gives us uhmm a challenge. We would not
be able to give 100% of the management if
there are relatives who would question us
from time to time
Respondent 2: Uhm.. Patients who are
dying. Of course lalo na kapag
naestablished ng naka…and then lalo na
kapag nakaestablish ka ng uhmm. bond
between the patient and the relatives and
then they look up to you and then after that
ahh in that state yung patient may toxic,
namatay, ilil… of course, burden sayo yon
as a doctor no.
Respondent 3: Mental state…parang di
masyadong affected yung mental state eh,
with regards to these patients kasi yung
mental state naman as a doctor, kahit ano
yung emotion mo, hindi siya dapat
magbago. I mean, kung galit ka, masaya
ka, naiinis ka, dapat yung mental state mo
or cognitive state mo is laging parehas,
ano, or very neutral. Ang ibig sabihin, wala
kang pipiliin. Galit ka man, masaya ka
man, same management yung gagawin
mo, same way of thinking yung gagawin
mo kasi lahat naman ito, at the end of the
day, patients mo.
Respondent 1: Well I just talk to the
relatives, explain to them what we need to
do, what we are doing and uh, the key in

Proposed Activities
1. What activities or coping strategies can
you suggest to other pediatricians who
experience the same problems?
36
handling these kind of problems is to
communicate properly. When you give
them explanations they cooperate. So it’s
communication.
Respondent 2: Okay. Ano to. Well... every
problems may be is a lesson. Is a lesson.
That next time. uhmmm…Next time you'll
be the best form of yourself no? Okay. And
then hindi naman tayo Diyos at kasi ang
Diyos naman ang nagpapagaling talaga.
Tayo lang is instrument ano? Buuut. We...
aid for the best.
Respondent 3: Problems that I
encountered, usually pag kaya kong
imanage, minamanage ko. Pero kasi sa
amin, bilang doctor, kung hindi mo kayang
imanage , kailangan mong irefer. Ano? So
dapat alam mo sa sarili mo kung sino yung
mga pasyente na kaya mong imanage,
kung sino yung patient mo na confidently
kaya mo silang itreat. Pero, pag hindi,
dumating ka sa point na, kahit ikaw, uhm,
nagdududa ka sa management mo, ano,
kini-question mo management mo, then
that’s the time that you have to refer the
patient sa isang, uhm, senior or
espesyalista na sabihin mo na mas
nakakatulong lalo sa patient kasi at the
end of the day, ang point lang naman natin
kaya tayo nagtatrabaho is para
makatulong sa patient. So, patient pa rin
naman. So, kahit alam mo na may kikitain
ka para doon or may makukuha ka dahil
sa ginagawa mo, kung hindi naman goal is
yung matulungan yung patient, wala ring
kwenta. Hindi naman ganoon yung
practice namin.
Respondent 1: Uh well uhm, there are
different kinds of strategies each doctors
face, each doctors use, so I could not
actually suggest what I’m using as a
strategy to other doctors. But for me, uhm
 37

whenever there is uh break time for me,

when there are no new patients inside the
emergency room, I usually take a breather,
30 minutes break of time, I would watch
movies or TV series and yeah that’s what I
do.

Respondent 2: Well let's see. You have

uhm. Strong, ahh. Foundation ahh.
..yourself…ahh. Coping up shall use as a
doctor. Nakikita ko siya as a psychologic
uhmm process na... malala ang contribute
with our environment. At home. And your
health, and kung healthy ka emotionally- at
kung healthy ka physically magiging
healthy ka din emotionally. Ganun dapat
yung target e no? Sige yun. Tapos na

Respondent 3: Patience. Lagi namang

ganoon eh, patience is a virtue. So ako,
sobrang haba ng pasensya ko. Ano?
Minsan lang ako pumipitik and once na
pumitik ako, ibig sabihin talagang sukdulan
na yung pasensyang binigay ko sa
pasyente ko or minsan (cough) nagagalit
lang ako pag hindi marunong makinig
yung pasyente or hindi cooperative,
ganyan. Pero, kailangan lang talagang
maging ano, eh, maging passionate ka sa
work mo, ano? Alam mo kung bakit ka
nagtatrabaho, kasi dapat alam mo rin kung
ano yung objective mo, kung bakit ka
nandito. Kung objective mo is yumaman,
magkapera and all, hinding hindi ka
magtatagal kasi hindi naman lahat ng
patients may pera at hindi naman sa lahat
ng pagkakataon kikita ka, ano? Dapat
yung goal mo pa rin is, kung ano yung
goal ng lahat ng doctor, kaya nagdoctor ka
is para makatulong sa patients.
 38

Profile of the Researchers

Name: Jana Maria Alyana N. Mendoza

Address: St. Francis Street, Tierra Verde Subdivision,

Pallocan West, Batangas City

Mobile Number: 0995 488 5254
E-mail: mndzjana@yahoo.com

──────────────────────────────────────────────────────────────────────────────

PERSONAL DATA
Date of Birth: June 16, 2002
Age: 16 years old

Place of Birth: Batangas City

Name of Father: Narciso A. Mendoza
Name of Mother: Glory Jacqueline N. Mendoza
Parent’s Address: St. Francis Street, Tierra Verde Subdivision, Pallocan West,
Batangas City
Religion: Roman Catholic
Sex: Female
Civil Status: Single

EDUCATIONAL BACKGROUND

Elementary: St. Bridget College

Junior High School: St. Bridget College
Senior High School: Lyceum of the Philippines University-Batangas
 39

Name: Peter Joseph V. Atienza

Address: 121 Orchids Street, Barangay Malitam, Batangas

City

Mobile Number: 0945 990 3088

E-mail: Peterjoseph@gmail.com

──────────────────────────────────────────────────────────────────────────────

PERSONAL DATA
Date of Birth: February 03, 2002

Age: 16 years old

Place of Birth: St. Patrick’s Hospital, Batangas City

Name of Father: Pedro V. Atienza

Name of Mother: Josephine V. Atienza

Parent’s Address: San Isidro, Tingloy, Batangas

Religion: Roman Catholic

Sex: Male

Civil Status: Single

EDUCATIONAL BACKGROUND
Elementary: Banalo Elementary School

Junior High School: Batangas National High School (Special Program in the Arts)

Senior High School: Lyceum of the Philippines University-Batangas

 40

Name: Erick Louie T. Magtibay

Address: Poblacion, San Pascual, Batangas City

Mobile Number: 0905 445 6172

E-Mail: elmagtibay@gmail.com

──────────────────────────────────────────────────────────────────────────────

PERSONAL DATA
Date of Birth: November 2, 2001
Age: 17 years old

Place of Birth: Saint Patrick’s Hospital, Batangas

Name of Father: Enrique B. Magtibay
Name of Mother: Lucia T. Magtibay
Parent’s Address: Poblacion, San Pascual, Batangas City
Religion: Roman Catholic
Sex: Male
Civil Status: Single

EDUCATIONAL BACKGROUND
Elementary: Princeton Science School – Home of Young Achievers
Junior High School: Lyceum of the Philippines University – Batangas
Senior High School: Lyceum of the Philippines University – Batangas
 41

Name: Precious Noelyn C. Villajuan

Address: Brgy. Dumantay, Batangas City

Mobile Number: 0918 270 7034

E-mail: preciousnoelynvillajuan@gmail.com

──────────────────────────────────────────────────────────────────────────────

PERSONAL DATA
Date of Birth: August 11, 2001
Age: 17 years old

Place of Birth: Nasugbu, Batangas City

Name of Father: Noelito K. Villajuan
Name of Mother: Jocelyn C. Villajuan
Parent’s Address: Brgy. Dumantay, Batangas City
Religion: Roman Catholic
Gender: Female

Civil Status: Single

EDUCATIONAL BACKGROUND
Elementary: Immaculate Heart of Mary Learning Center and School of Values
Junior High School: Lyceum of the Philippines University-Batangas
Senior High School: Lyceum of the Philippines University-Batangas
 42

Name: Lhance Stephene G. Enriquez

Address: Brgy. Kumintang Ilaya, Batangas City

Mobile Number: 0956 811 9541

E-mail: xxlhancexx@gmail.com

──────────────────────────────────────────────────────────────────────────────

PERSONAL DATA
Date of Birth: October 08, 2002
Age: 16 years old

Place of Birth: Sto. Tomas Tingloy, Batangas

Name of Father: Engelbert C. Castillo
Name of Mother: Judith G. Enriquez
Parent’s Address: Brgy. Kumintang Ilaya, Batangas City
Religion: Roman Catholic
Gender: Male

Civil Status: Single

EDUCATIONAL BACKGROUND
Elementary: Tinloy Central School
Junior High School: Lyceum of the Philippines University-Batangas
Senior High School: Lyceum of the Philippines University-Batangas