"Sound" Advice for My Pediatric Colleagues

I have been a pediatrician for nearly 30 years. I have practiced in affluent suburbs and in poor inner cities and have cared for patients from many religious, ethnic, and cultural backgrounds. Experience has taught me that there are certain ways to approach a child's parents that are nearly universally appreciated. These approaches and techniques have become particularly important because pediatricians nowadays have less time to spend with each patient--because of financial and insurance pressures--and therefore must establish rapport quickly. Physicians who are perceived to be more friendly and less hurried get sued less often.¹

Greet the parent by name. When you enter the examination room, address the child's mother or father by name. Remember, of course, that the parent's last name may not necessarily be the same as the child's. Even though many parents will not correct you if you call them by an incorrect last name, no one likes to be misidentified. So, "Hello, Ms Smith, I'm Dr Fischer," is my greeting. I don't call mothers "Mom," "Mother," or "Momma." These terms strike me as patronizing. (She's calling you "Doctor," and you're calling her "Mommy"?)

Shake hands. I shake hands with the parent and I also attempt to shake the child's hand if he or she looks old enough to understand the gesture. One of the fundamental tenets of the doctor-patient relationship is that of the laying on of hands.A handshake also shows respect, suggests friendliness, and diminishes the social distance between doctor and patient. When you ask a child to "shake" or to "give me five," the parent is usually pleased if the child understands and complies. This enables the physician to see that the parent is proud of the child's accomplishments. The child also sees that the physician is perhaps not as frightening as he imagined.

Consider your physical position relative to the patient. When I talk with parents, I sit down. I try to use the lowest chair in the room. My favorite seat is a molded plastic chair designed for a preschooler. If the patient is seated on her mother's lap, she doesn't have to see a strange adult towering over her. Similarly, the mother does not have to look up to talk to me.

Never trivialize a complaint. I never tell a parent that the presenting symptom, complaint, or physical finding "is nothing." Even if it is so trivial as to be just about nothing, saying so makes people feel stupid and that they're wasting the physician's time as well as their own.

I don't believe it's helpful to tell a parent, "Don't worry." Parents worry anyway. Instead, I've found that patients are reassured if I say, "Don't worry too much. I know good parents worry about their children, but the current problem is not worth much anxiety."

Anticipate parents' reactions. When a child is found to have head lice or scabies, some parents think that the physician suspects their family of being dirty. In the lay mind, ectoparasitic infestations are associated with filth. I've had parents cry when told their child has head lice. Parents have even asked me if they should discard all their furniture and pull up their carpets. The wise pediatrician will save time and make himself or herself appreciated by preempting the parents' discussion of risk factors. Once I tell a parent that the diagnosis is lice or scabies (or tinea, for that matter), I follow up by saying that "any child can get this" and that it is "no reflection on the cleanliness of the child or the home."

A little bit of embellishment helps. I've had parents tell me that their child has been diagnosed with a "hole in the heart." What might this mean to a medically unsophisticated parent? If a parent understands the heart to be some sort of a "bag" (even a bag made of muscle), he or she may not understand that the "hole" refers to a septal defect unless you offer some insight about the heart's anatomy. If there is a hole in the heart, won't blood leak out? Where will it go? This sounds serious. You can help by explaining that the child has a "hole in one of the walls inside the heart. These walls divide the heart into separate rooms."I've seen visible relief on parents' faces after hearing this supplemental explanation.

The bottom line. Parents want to be treated with respect and to be put at ease. This does not require great effort on the pediatrician's part. Communication is most successful when ambiguity is eliminated. The physician owes this to parents and will find that it makes life easier for all concerned.

References:

REFERENCE:

1.

Levinson W, Roter DL, Mullooly JP, et al. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.

JAMA.

1997;277:553-559.