These are frightening to parents when they first experience it.

They may happen at any time from about six months to four years. They tend to develop as a result of frustration or anger in the child or they may follow a period of denial by the parent, or a fall or when the child can’t get his own way with other children.

In an attack the child breathes right out. Then comes a period when he doesn’t breathe at all. During this period his face may become congested and take on the bluish red tinge of cyanosis. Twitching of the muscles may occur and then he usually loses consciousness. There could be loss of control of the bladder at this time.

After loss of consciousness, the child starts to breathe again and quickly returns to normal. At that stage the parents are left in great panic.

Treatment consists mainly in counselling the parents, who must understand that this is an attention seeking device and that the way to overcome it is to ignore the child.

It is, of course, not easy to tell parents to walk away from the child when he is going blue in the face and losing consciousness.

Children usually grow out of this habit, but by this time a poor parent-child relationship may have developed with the child able to manipulate his parents.

The parents need counselling so that they can fulfil properly the emotional needs of the child and help him overcome his anxiety.

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Say you are considering having a ‘breast’ reconstructed after a mastectomy (removal of the breast). Ask to be referred to a plastic surgeon who has done a lot of these operations. Only someone with plenty of experience is in a position to explain beforehand exactly what result you can expect, and then to actually produce the promised result.

All of these are just examples. If you are in doubt about the experience of your doctor, ask directly how often he or she has done the procedure in question. Ask whether there are doctors who specialise in the procedure and, if there are, ask to be referred to them.

A word of warning: specialists have advantages when it comes to knowledge, experience and technical skill. However, they also tend to have a major disadvantage — they are less likely to see you as a whole person. Specialists do not take a broad view, on the contrary, they tend to take a very narrow view. Specialists tend to see their patients as caricatures, with the particular aspect they are interested in blown up out of all proportion to everything else. They may even act as though other aspects of their patients don’t exist.

Try to think of your specialists as resource people who have a lot of very specialised knowledge, some of which they can share with you. They also have special expertise which you can take advantage of, if you choose. However, even if, for example, someone knows everything there is to know about chemotherapy and is very experienced at giving it, this still does not make them the best person to decide whether you should have chemotherapy. The best person to decide is someone who knows a bit about your cancer and what you can expect from chemotherapy, and a lot about you—your values, priorities, expectations, strengths and weaknesses. That person is you.

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