Minor Thoughts from me to you

How Should Pediatricians Help?

After reading my last post on parenting and responsibility, two people raised the same objection: what about parents who don’t know about proper safety or about the resources that area available to them?

[T]here are many parents out there who are ignorant of the statistics on bike helmets, car seat, proper gun storage etc. AND many parents may not know that there are organizations to help needy families obtain safety items for free / reduced cost. If a doctor isn't allowed to ask questions, how can the information reach the parents who may need it?

It’s a fair question. How should society balance the desire to help people against the tendency to annoy people who don’t need help?

I think we need to start with respect. A pediatrician who questions parents, on their first visit, about their parenting skills risks appearing condescending and disrespectful. A pediatrician who claims that it’s his job to protect my children, implies that he doesn’t think it’s my job and that he doesn’t trust me to keep them safe.

I think the default assumption should be that parents are concerned about their children’s welfare and want to do what’s best. When a pediatrician starts by asking parents “do you do this?”, it communicates disrespect and distrust. From what I’ve read in recent articles, and from what pediatricians are defending, it seems that the normal approach is to grill parents with an invasive and potentially judgmental checklist:

  • Do you own a pool? Is it kept covered and locked when not in use?
  • Do you own a gun? If so, you shouldn’t. If you insist on doing so, here are the rules that you must follow so that your children don’t suffer from your obstinacy.
  • Do your children ride bikes? Do they wear helmets all of the time or do you actually want them to die?

Now, I’m well aware that doctors aren’t quite that confrontational and insulting when they’re talking to parents. On the other hand, that’s often how parents perceive their questions. Especially when they’re asking those questions without first getting to know them and without first learning what their level of parenting competency is.

What should they do instead? Well, riffing off of a comment from a nurse I know, how about a general presentation of what they can do to help?

Hi, I’m Doctor Smith, your daughter’s pediatrician. I hear that your daughter has an ear infection today. We’ll make sure you get some general antibiotics to clear that up as quickly as possible. Since this is the first time we’ve met, I’d like to tell you a little about what we do here at the office. Obviously, we’re here to help you anytime your children get sick or have an injury.

We’ll also help you to keep your children up to date on vaccinations and immunizations—the immunization schedules can be confusing, so don’t hesitate to ask if you have any questions. We’re also available to answer any questions you might have about general parenting topics. If you’d like, we can help you with understanding childhood nutrition, recommended diets, learning styles or disabilities, or other topics related to childhood development.

Surprisingly, the biggest risks your children face today aren’t from sickness or disease but from accidents. Nearly 30% of all childhood fatalities result from either motor vehicle accidents or drownings. We’d love to help you learn about the best way to prevent these accidents. We can talk to you about car safety, pool safety, bike safety, firearm safety, etc.

More than just medicine, we want to do everything we can to help keep your children safe. Is there anything you’d like help with today? If not, feel free to call or email the office anytime you have a question, day or night.

Beyond that, the doctor’s office could have posters prominently displayed, advertising proper safety or offering to counsel parents about safety. They could have posters and handouts, advertising local organizations that offer free / low cost car seats or safety devices. They could offer instructional DVDs (or link to online videos) that teach parents about proper safety and available resources.

There are many ways that pediatricians could offer help and resources without taking responsibility away from parents or without defaulting to a confrontational style of questioning. My post about parenting and responsibility wasn’t saying that pediatricians can’t offer advice. Far from it. The responsible parent will seek out advice from many sources. But there’s a large difference between solicited and unsolicited advice.

If you wait to be asked, you’ll communicate that you respect your patients and trust them to be responsible. If you freely give unsolicited advice, you risk communicating that you look down on your patients and don’t trust them to be responsible without your help.