It’s tough to be the expert in the room when your professional opinions are being resisted. When pediatricians’ best efforts are resisted or worse, ignored, it can be detrimental to the relationship of trust necessary for an ideal medical home. While it’s natural to get emotional about certain topics, noncompliance or defensiveness in response to a physician’s guidance is a result of parents challenging their pediatrician, and not the patient. In this post, we’ll outline a few difficult topics pediatricians commonly run into, including difficult diagnoses, finances, and misinformation, as well as ways pediatricians can reframe blame and shift focus back to what matters most: the best health outcomes for the child and family.
Being Present in the Struggle: Pediatricians & Sensitive Topics
It’s normal for toddlers to have tantrums: they have big feelings and they’re learning to deal with emotions for the very first time! It’s also normal for adults to have big feelings they don’t have the tools to deal with, too. Just as parents can recognize the triggers that ‘set off’ their child into an outburst, pediatricians can identify topics that trigger big responses in parents — and themselves.
Sensitive topics are unavoidable. Consider the following situation: a parent brings their child in for a behavioral health evaluation. After a screening, the pediatrician advises the patient and parent that the child shows strong signs for depression, with risk of suicide. Before the pediatrician can begin to list guidance such as support resources, referral to therapeutic services, or medications, the parent begins to angrily refute the physician’s diagnosis, citing their own internet sources and demanding a second opinion.
This is the point where communications can break down. Pediatricians are responsible for identifying diagnoses and providing guidance for a child’s best health outcomes, but this information isn’t always easy to give or to receive. Whether it’s a difficult diagnosis, finances, parenting, differences in culture, misinformation, or even discussions of chronic illness or death, these sensitive topics can result in surprising and vehement responses from both parents and physicians.
Pediatricians are experts in children and their development, but it’s important to remember during sensitive conversations that parents and caregivers are the expert on their child. Just as a pediatrician would never describe a child as a “problem child” but a child experiencing problems, parents bring their own struggles and beliefs into the exam room. It’s easy to experience discomfort and even defensiveness when a parent refutes data that to the physician is as plain as day.
It’s impossible to control another adult’s emotional response, but pediatricians can begin mediation by identifying their own biases and emotional triggers. Let’s examine some responses pediatricians might experience when facing a challenging conversation:
- “They’re not listening! I’m just presenting the data as it is!”
- “I’ve told them this three times before that their strategy won’t work. When are they going to do as I’ve suggested?”
- “Who told them that? That’s not correct! I’m so annoyed with social media presenting misinformation to people.”
- “I have been successful at my job for many years. Why are they challenging me?”
- “I’m being yelled at and therefore I have lost respect and sympathy for this person. I want to get out of here.”
It is unsurprising that many of these responses could be from the parent or pediatrician. In the end, emotional responses often come from a place of vulnerability and fear: I am afraid of what I don’t know; I am not being listened to; I am being scolded or disbelieved.
Reassurance and reframing can help the other person feel seen and understood, while inviting collaboration can offer reassurance in itself. For example, “I see that you’re upset about this diagnosis. You are welcome to get a second opinion, as I know that being certain is very important. Let’s review a list of local doctors together. I would be happy to work with them to ensure Sam gets the best care possible.”
While reframing and reassurance can diffuse a tense moment, it is important for pediatricians to establish firm and immutable boundaries, such as when they feel physically or emotionally threatened or when the parent is asking for service that is unreasonable. Phone calls after hours to a family friend? Yelling in the office? Online misbehavior that names your practice or staff? Decide what is not okay, and put action plans in place to correct the behavior or recommend a different practice that could serve this family better.
Triggers and Tantrums: Sensitive Topics in Pediatrics
It's crucial for pediatricians to navigate these sensitive topics with sensitivity and empathy, always remembering that everyone shares the goal of a happy, healthy child. Here are some strategies from the National Center on Parent, Family, and Community Engagement that can help:
- Active listening: Take the time to truly understand the concerns and emotions of the parent. Show empathy and validate their feelings, and encourage them to tell their side of the story.
- Educate and inform: Provide evidence-based information and explain the rationale behind your recommendations. Highlight the potential benefits and risks involved, while acknowledging parents’ concerns.
- Collaborative decision-making: Involve the parent in the decision-making process. Empower them to be active participants in their child's healthcare journey.
- Cultural competence: Respect and appreciate cultural differences, and depend on trust built over time to bridge gaps in opinion and decision-making.
- Remember the goal: the goal is a healthy, happy child. Everyone’s goal in the medical home is the same, and focusing on the goal rather than the friction can help parents and pediatricians collaborate.
This last strategy, remembering the goal, is an example of positive reframing. While pediatricians should weigh the evidence as to how to handle a difficult situation with care, positive reappraisal can help diffuse tension and restore empathy and trust in a tight spot. It can be useful after the tense moment, too, wherein pediatricians and parents can meet again and review the subject in a new light.
The point is not always to “look on the bright side”, but to reconsider the motivations and fears in the room, and decide how to address them – whether they’re coming from the parent or the pediatrician.
Navigating sensitive topics in pediatric care can be challenging for both pediatricians and parents. By approaching these conversations with sensitivity, empathy, and a focus on collaboration, it is possible to build trust, understanding, and ultimately achieve the goal of a happy, healthy child. Active listening allows pediatricians to understand the concerns and emotions of parents, while providing evidence-based information can help alleviate their worries. Involving parents in the decision-making process empowers them to be active participants in their child's healthcare journey, and respecting cultural differences fosters mutual respect and effective communication. It is important for pediatricians to establish boundaries when necessary, ensuring the best care for their patients while addressing any unreasonable requests or behaviors. By following these strategies, pediatricians can effectively navigate sensitive topics and foster strong relationships with parents, ultimately leading to better health outcomes for children and families.
