The relationship between parents and pediatricians

It’s strange being on the other side for a change. I remember bringing my son to his first doctor’s appointment.  A new mom. No stethoscope around my neck. No patient schedule, replaced instead by the constant grind of breastfeeding.

I knew it was just another routine newborn check for our pediatrician, but every maternal fiber in me believed that my son must be the cutest baby that ever walked through that clinic.  Every thing he did, every coo, every gurgle and smile, every moro reflex …  It was all so incredible to me, as if these were breakthrough accomplishments in the entire history of all babykind.  I was a proud and excited mama.

I like my pediatrician and I value her input and advice.  She’s efficient and knowledgeable.  But I distinctly remember walking away from that first appointment feeling ambivalent simply because she didn’t ask any personal questions to get a sense of who we were as a family.  I didn’t expect this to be a social visit; I didn’t want to be treated any differently because I’m a pediatrician.  But I would expect that knowing the social context of a new patient is an important step to building rapport.

I have always wondered what parents think of me as their pediatrician.  If only I could hear the running commentary of thoughts that goes on in their minds.  Would I laugh?  Would I cry?  Sometimes it’s obvious that a great rapport has been built.  I love it when that happens.  I feel like I am actually being useful.  But sometimes I get these blank expressions.  In some cases, I can blame it on my mediocre Spanish.  But if they speak English…. well….

Some medical schools videotape their students as they meet  and examine “practice” patients.  I wish it was something doctors out in practice could do.  I’m sure I would cringe at some of my habits and body language, intentional or not.  I’m sure it would also inspire me to wear more make-up and actually do something with my hair.

When I listen to people talk about their kids, it sure doesn’t sound like they look to their pediatrician as a resource for parenting advice and support.  Is it because people don’t realize how to maximize the use of their pediatrician?  Or is it because the pediatrician hasn’t conveyed an interest in the broader scope of their child’s development and behavior?

I went into pediatrics because I loved the idea of getting to know families over many years.  I had hoped to play an active role in helping parents bring out the potential of their kids.  Now I wonder if that’s even realistic.  Maybe our current approach to health care, as a system and as a culture, simply doesn’t encourage this kind of relationship between parents and pediatricians anymore.  Perhaps society has become too mobile.  Rarely does anyone stay with one job, let alone one doctor.  The part that troubles me most?  I’m beginning to wonder if being the pediatrician I envisioned is simply not possible when I’m choosing to work only two days a week.  I just can’t be there for these families in the way I had hoped.  That’s a tough pill to swallow.

Yolanda Wong is a pediatrician who blogs at Well Child Chats.

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  • http://natickpediatrics.net Rob Lindeman

    Yolanda,

    Congratulations on becoming a new mother! It’s the greatest, toughest job you’ll ever do.

    A couple pieces of advice from a fellow pediatrician, dad, (former) blogger:

    I hope sincerely that Yolanda is your real name. Please don’t blog anonymously. I know whereof I speak.

    Lots of parents simply don’t want to get any closer to you as a person. Sometimes they just want you to be a pediatrician. Sometimes a pediatrician doesn’t want to get any closer to his/her families in a personal way. There is nothing at all wrong with any of this. It’s life.

    Finally, regarding working two days a week: I envy you. But you’re right, you can’t build relationships this way.

  • http://hokiemd.blogspot.com Christopher Bayne

    Your commentary made me think of something, though I don’t know if it’s wholly related to your story.

    I’m a fourth-year student. In my four years of medical school, I feel I have a pretty good grasp of the different personalities in my class. I’m working with them under intense pressure, so I get to see their bad sides. I’m also celebrating with them after our accomplishments, and I see them having fun while working with patients, so I get to see their good sides.

    At our match day, it was clear to me that some students chose a speciality that naturally fits with their personality. Although they are stereotypes, you can pinpoint the “serious surgeon” or “playful pediatrician” from a mile away. When these people opened envelopes to ” Children’s Hospital,” no one was surprised. Yet I shook my head when other students opened their envelope: “Wait, so-and-so matched into pediatrics? Gosh, the kids and parents are going to hate him.” After four years with people, you just get hunches.

    Some of my classmates will make amazing pediatricians. I can see them trying to take kids home rather than give them back to their parents. They will draw parents into a relationship and invest time in their patients’ families. And for the others? I’ve thought that maybe pediatrics is a way for “control freaks” to feel like they have maximum control over their patients. There is a potential power dynamic (or, maybe an “ego-centric fulfillment” is another way to describe it) that exists between a between a seasoned physician and a child. And at the same time, there is something “heroic” about healing a child while its parents sit in the background, hoping and praying for a good result. This same dynamic doesn’t often exist in most fields, including my chosen field, urology.

    Looking at my classmates, I can’t help but think some want to be involved with lots of families. Is there any part of the others that simply want to be able to stand over their patients and heal with the rest of the room watching in awe?

    Just my immediate reaction to your piece. I’m not claiming they are valid.

  • Anna

    The NYTimes diagnosis piece from last week (by Dr. Lisa Sanders) – http://nyti.ms/g6LXp3 – featured a pediatrics case. I followed it with great interest. In the solution, and the comments from Dr. Sanders responding to readers’ post it was clear that the fact that the mother had an established relationship with the pediatrician allowed for a more timely diagnosis of a devastating illness. The fact that the doc knew the mother wasn’t one to overreact or exaggerate symptoms meant the relatively minor symptom of hair loss was taken seriously and labs were drawn which led to other abnormalities. It’s clear that without that relationship the mother and child may have been dismissed as hysterics.

    One reader’s comment made the point, which I believe to be valid, that the doctor/patient relationship saves lives. The relationship you establish today, may well be the reason a timely diagnosis is made years from now. It is, I believe as important as any therapy medicine may offer. It will be interesting to see in the years to come, if diagnoses are made later than they were in years past – and if failing to establish a good relationship with patients may be the reason.

    I personally feel that doctors today do not value the relationship as much as they did in years past. I know that, in spite of many attempts, I have not found a PCP that offers it. I understand the reasons. I empathize. But, I can’t help feel that it results in poorer care.

  • http://blaggieplaggie.blogspot.com Yolanda @ Blaggie Plaggie: Babblings of a Mommy Doctor

    These are some interesting responses that I wouldn’t have expected when I initially wrote this. I really appreciate them though… they’ve given me some food for thought.

    Yolanda is my real name. I take what I write seriously and wouldn’t want to hide behind a pretend name. However, I’m new to this blogosphere world and am still uncertain about the level of privacy I’d like to maintain. Any thoughts or personal experiences regarding this?

    I understand that every physician has their own approach in building rapport with patients. Some get more personal and chummy. Some not. And that’s fine. My main concern and question is what the expectation and definition of a pediatrician is nowadays. We are trained and taught (hopefully) to strive for something more than just an urgent care approach. But the more I talk with mothers, and the more I read the responses of parents all over the internet, it sure doesn’t sound like many people are looking to their pediatrician as a trusted and worthwhile source for parenting support. What are the factors in this? Is it the system? Is it us? Is it them? Is it the internet? It’s all of the above, and I have no answers as to how to bridge the gap again between pediatrician and patient, but I know it’s something I find worth striving and hoping for.

    In response to Anna’s comment, I do heartily agree in the prevailing importance of a solid trust built between a pediatrician and the parents of a child. I recently experienced the benefit of this when a mother of a premie finally decided to stop cosleeping after we had discussed it multiple times. It’s not a breakthrough diagnosis, but I do hope these are the conversations people can be willing to have with their pediatrician.

  • Angela Caffaratti, MD

    Yolanda,

    I find that all patients want a different relationship. Some value it more than others. Some just want you to give antibiotics for everything and some want your advice about everything. Let the patient and you decide together. You can’t be everything to everybody, but you can make a big difference in every encounter. I worked three days a week when I had babies and it was hard to build rapport. Now that my kids are older, I work daily and get out early to be home with them after school. Do what you can to be the best of both mother and doctor. It isn’t easy, but it is great. Also, make sure you have time for yourself once a week. Good luck.

  • michelle

    well, when pediatricians offer parenting advice that just doesn’t seem to mesh w/ my instincts, I stop listening. Breast feeding advice is an example – supplementing with formula because of slow weight gain when the baby otherwise is thriving, nursing after 6 months or a year, the all over the place advice of when to start solids.

    I’ve had some advice given that just makes my head hurt. It’s fine to have an opinion about parenting issues, but I really only go to a ped. for medical advice and monitoring. I’ll leave parenting advice to those who have been there done that – no offense intended.

    I have 9 kids now, and love my family doctor who trusts my instincts. I think we need to do a better job of not making parents feel incompetent and needing “expert” advice regarding parenting. Gentle guidance and respect are important.

  • http://www.littlepatientbigdoctor.com Haleh Rabizadeh Resnick

    Dear Yolanda,

    I am also a mom and author of the book, Little Patient Big Doctor: One Mother’s Journey. I would say that everyone wants a relationship with their doctor and that every doctor should strive to have a relationship with their patients.

    Medicine is very much a people job. It’s tough to be a good doctor if you only love the science of medicine and not the people who come to you. You may be an amazing diagnostician but without a relationship with your patients, you may get misinformation and fail in helping your patients.

    You can build a relationship with only working two days a week. How? If each time a patient walks in, your goal is to have that relationship with them, I can guarantee you that over time, when they can, patients will choose to come in only when you are available.

    Thanks for your words,

    Haleh

  • http://www.confessionsofadrmom.com Melissa (Confessions of a Dr.Mom)

    This really resonated with me, as a pediatrician and mom myself. I remember the first time we took our newborn to the pediatrician, it was an eye opening experience.

    I too struggle with the way I envision practicing medicine and the reality. I only work two half days a week so I can be home with my children and raise them. It’s tough. Thank you for giving this struggle and dilemma a voice.