JAMA & ARCHIVES
Arch Fam Med
SEARCH
GO TO ADVANCED SEARCH
HOME  PAST ISSUES  TOPIC COLLECTIONS  CME  PHYSICIAN JOBS  CONTACT US  HELP
Institution: CLOCKSS  | My Account | E-mail Alerts | Access Rights | Sign In
  Vol. 4 No. 3, March 1995 TABLE OF CONTENTS
  Archives
  •  Online Features
  Brief Report
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal

The 'Maternal Grimace' Sign

A Clue to the Importance of the Contextual Diagnosis

Christopher C. Butler, MRCGP

Arch Fam Med. 1995;4(3):273-275.


Abstract

Parents sometimes present illness in a child as an expression of their own distress, and patient-centered medicine attempts to address the underlying causes of problems by incorporating psychosocial factors in the diagnosis. However, in the real world of busy primary care, it is not always possible or appropriate to broaden every consultation, and the clinician may have to rely on certain clues that suggest the importance of exploring hidden reasons for consulting. Two cases are presented in which a mother's dramatic grimace during the gentle examination of a comfortable child alerted the clinician to parental anxiety disproportionate to the child's illness. Addressing parental anxiety proved fruitful. This "maternal grimace sign," pointing to the importance of the contextual diagnosis, underlines the usefulness of careful observation of all those involved in the consultation and may have implications for the way clinicians choose to position children and parents during physical examinations.



Author Affiliations

From the Department of General Practice, University of Wales College of Medicine, Cardiff.



THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clues to Patients' Explanations and Concerns About Their Illnesses: A Call for Active Listening
Lang et al.
Arch Fam Med 2000;9:222-227.
ABSTRACT | FULL TEXT  




HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1995 American Medical Association. All Rights Reserved.