If you had asked me what I anticipated to be the hardest aspect of pediatrics when I was in medical school, I would have said the loss of a pediatric patient. This isn't to minimize the loss of a patient, but my answer has changed. If you were to ask me now, without hesitation I would answer: The parents. Not all parents, but certainly the difficult parents of patients.
It's no surprise that a specialty dedicated to the care of children entails parental involvement. A pediatrician cares not only for their pediatric patients but also for their patients' guardians. This relationship is unique. When it's positive, the physician, patient and parents and/or family members serve as a team committed to the health of the patient.
At times, though, this dynamic breaks down. What does that look like? A list of some of the toughest parts of residency thus far would include:
- When parents call me into the room to yell about an aspect of the plan that I don't have the unilateral power to change.
- When parents deny their children care.
- When parents, in the heat of a FaceTime call for medical updates, threaten the lives of all members of the medical team.
- When an enraged patient's father follows me from the hospital.
The ability to handle such circumstances with grace is challenging but imperative. Here are a few ways to bridge the gap.
Acknowledge parents' expertise
As physicians, we have a monopoly on physiology and pathology. As pediatricians, we know the nuances of pediatric medicine and management. That is our expertise.
In the space between academic medicine and clinical medicine is nuance — the art of medicine. We acknowledge that there is some limitation to our expertise. I have often heard my attendings say to parents: "I can reasonably call myself an expert of [insert pediatric pathology], but you are the expert of [insert patient's name]." This statement is powerful because it makes clear to the parent that their concerns and contributions are of specific value to the team.
Acknowledge parents' intent
It would be dishonest to claim that these circumstances aren't frustrating. What I have found helpful is making an effort to understand my patients' parents' motivation.
Almost universally, parents are dedicated to the health of their children; this goal is in line with ours. I remind myself that parental behavior that's obstructive to care is rooted in passion and concern for their child. A conversation between provider and parent that appeals to that commonality can reestablish trust and stabilize the dynamic.
Establish boundaries
If challenges continue to arise, it's vital for the medical team to establish boundaries by addressing the ways in which parents/guardians speak to the medical team.
We want to approach our families with care because we're aware that the hospitalization of a family member can induce anxiety. Nonetheless, the medical team shouldn't have to withstand abuse. It's imperative to have a frank conversation about appropriate behavior in case of further need for escalation.
Put the patient first
In some circumstances, parental obstruction to care can constitute abuse. These circumstances are emotional, challenging and uncomfortable. In these moments, we have to remember that our patients are our priority, and the measures to keep them safe are nonnegotiable. Efforts to maintain safety could require conversations with your hospital's risk management/legal team or child protective services, depending on the nature of the misconduct.
The field of pediatrics is special, and the opportunity to touch the lives of children and their families is such a privilege. The anxiety of the unknown can create circumstances where parents become resistant to medical decision-making or even become obstructive to care. Dealing with difficult parents of patients is by no means easy, but it is an unavoidable part of our line of work. In most circumstances, an open heart and open communication can realign parents and providers.
