Taking a medical history in childhood illness: representations of parents in pediatric texts since 1850

Abstract

The pediatric clinical encounter is initiated when a sick child is presented to a physician and the physician takes a history from the parent. This article casts the physician's construction of that encounter in a central role in the history of the theory and practice of children's medicine. The focus is on what physicians have written about the conduct of such encounters, and specifically on their attitudes to and instructions for the taking of a history. This analysis reveals that medical writings on the taking of a medical history provide a window into how pediatric writers wanted their discipline to be conducted, what they identified as the normative principles of pediatric practice, and how they portrayed parents. The texts show a striking continuity in the ambivalence expressed by practitioner authors about the parental role in the clinical assessment of sick children. What emerges is both a regret that the physician must be dependent on parental history for clinical assessment, and a message that any doctor dealing with children should both value the parental history and distrust it. Because history taking is a fundamental, core medical activity, these normative principles and representations of parents were dispersed easily, widely, and unconsciously within pediatric practice. They also provide a link to the wider contexts of physicians' involvement in child rearing, the influence of psychiatry, and the fundamental gender structure of the clinical encounter.