When a patient request periodic health examination (PHE) or screening tests, physicians may assume it is for detection of an asymptomatic disease. In this context, most recommendations for PHE/Screening are based largely on the prevalence of preventable disease in asymptomatic individuals [1]. However, a prospective study has shown that the majority of patients with demand of a check-up were motivated by some specific symptoms and health concerns and were not “asymptomatic” [2]. These aspects may be systematically ignored or overlooked in PHE consultations while the physicians tend to focus on delivering recommended screenings.
The presence of a physical symptom with no obvious diagnosis, apparent cause, or clear mechanism can give rise to feelings of uncertainty, anxiety, and impotence in the patient. In the absence of clear and reliable information, people often suspect that their symptoms are caused by the disease everyone dreads [3]. Parents who feel that their child’s health is threatened by a symptom will request diagnostic tests to understand the mechanism of the disease.
Patients who consult a physician have many doubts, fears, and expectations, and some of these concerns may never be expressed if the physician do not proactively elicit them [4]. Also, if a physician elicits parents’ concerns about their child’s health problems, it can help the physician to manage prevention, diagnostic and treatment process. In a study on autism, it has been shown that eliciting parents’ concerns about their child’s development was a key component of early detection of autism [5]. In a study on factors associated with parent concern for child weight and parenting behaviors, overweight parents are more likely to have concerns about overweight status in their own child [6]. Also, the study showed that the parent's concern about their child's overweight status is an important precursor or determinant of preventative actions. Several studies provided evidence for parents’ concerns high sensitivity in identifying developmental delays in children. Parents’ concerns for speech, language, motor or cognitive skills were indicators of developmental delay [7–10].
In addition to parent's concerns for own children, the parent's wishes—in other words, the expectations they have when they consult a doctor—are important facet of hidden agenda. Parents may also have specific expectations for their children, such as requesting a diagnostic test or procedure. Furthermore, physicians need to be aware of “hidden agendas”, as patients often request screening tests as a reason for consultation to raise the issue of a specific problem that troubles them, to use the family physician as a counsellor to discuss problems, to seek reassurance regarding undeclared symptoms or to feel relief [11]. Patients who request screening tests/PHE may expect more than just routine screening in accordance with the current clinical guidelines [12–14].
There is an extensive body of research concerning the identification of parental concerns regarding specific groups of parents, determined medical conditions or different children’s problems [15]. The results of a longitudinal study indicated that negative behaviours were the most frequent cause for concern and that there were certain ages (2–3 years old) that caused more concern in parents [16]. A study (2006) using data from the 2003 National Survey of Children's Health, with 102,353 children from the United States, reported rates of parental concerns about emotional, developmental, or behavioural problems much higher than the rates of children that were actually diagnosed with those problems [17]. In a study which identified parents’ concerns in 1202 Australian parents of children from 2 to 16 years old, parents were mostly concerned about their child’s education (35%), child’s health and well-being (25%) and violence, drugs and alcohol (20%) [18]. The studies named Parents’ Evaluation of Developmental Status provided evidence that parental concerns were highly predictive of behavioural and developmental problems in children [19].
While previous researchers provide insights into parental concerns about emotional, developmental, or behavioural problems in children, it is not known how children's complaints/symptoms and possible medical conditions related to these complaints/symptoms impact parent concerns. The current study investigates concerns of parents visiting a family physician to request screening tests for their own child.