People are told by big media that doctors will probably hurt you and you will never see it coming.  They are told to stick up for themselves, be an advocate for your child/parent/dependent.  Ask for more tests.  They must be missing something.  Ask for more consults.  A second, third or fourth opinion must be better.  Don’t leave without an answer and don’t compromise.  Then they actually become patients.  Or in my case usually parents of a patient.  I’m a pediatric hospitalist and when people become patients the expectations change.

I would like to think I’m an expert of sorts.  I’ve spent many years studying pediatrics, becoming board certified, and I continue to read new evidence when it is published.  My job is to practice evidence-based pediatric hospital medicine which means I only order the tests I need for a patient and only consult specialists that are required. As soon as the patient is ready, they are discharged.  The workup can continue outpatient as appropriate.  This is in direct opposition to what the public is taught about medicine.  The opposition is so difficult it can actually impair the relationship between provider and patient.

Pediatricians do family-centered rounds.  The rounding team includes attending physician, RN, residents, students, pharmacist, social worker, charge RN, and nursing case manager.  It also includes parents in rounds, discussing the presentation of the patient, differential diagnosis and plan.  Some families love this collaboration in their child’s care.  They have questions that get answered, and they can give advice and input about the plan.  They are our teammates, and everyone hears the same plans and the care moves forward.  Some parents are intimidated or overwhelmed by the entire team rounding with them.  They are either quiet for rounds, or they refuse to attend rounds.  They may not agree with the team’s plan, or they do not know what to do as they feel they have too many options and don’t trust the team’s guidance.

Parents at times advocate so strongly for their child that they are obstructing the care of their child.  They don’t trust the team or providers. They think they are doing the right thing which often puts them at odds with the rest of the medical team.  These parents take more time to round on; the families are frustrating to care for and decrease staff satisfaction.  Hospital staff actually avoid going into the patient’s room.  They avoid these difficult adversarial conversations.  The way families and doctors are positioned in modern media puts us on separate teams.  Didn’t anyone tell these well-meaning parents their behavior will decrease the safety and health of their child? Why are we keeping this a secret?

There must be a better way!  Why are some families unaffected by the onslaught of popular opinions that doctors are hurting more than healing?  Somehow the personal relationship and trust that they have formed with the providers wins out over all the doubt previously heard.  They can have a discussion with the professionals who know and understand the evidence and will share it with them to make a decision about their child’s care together.  How do we make this more universal and make those who do not believe in the team have trust in this system?

When polling for patient satisfaction, the well-meaning but poorly advocating families don’t believe that their child was well cared for. They didn’t get all the tests, all the consults, all the second opinions that they asked for.  They previously were told that they needed these things to affirm they were doing their job as a parent.  A doctor explained that their child did not need this and that now it is safe to go home. They were treated with a minimum of testing and consults and length of stay, all per evidence-based recommendations.  Their child improved. They will be dissatisfied.

We need to change the expectations.  We need to recruit these families to be members of our team from the beginning and to work together to improve the patient’s health.  We are not adversaries.  We need to rebuild the trust in this system.  As we try to navigate why our medical plan is not working or why there is so much resistance, we need to think of what the family is concerned about.  Why are they no longer team members?  Explain the evidence and how the team makes decisions.  Time out and let’s get back on the same team with the same goal: to improve your child’s health.

Satisfaction should be about practicing appropriate medicine and improving health.  The value should come when a doctor knows the right tests and orders them.  Satisfaction comes when your length of stay is short and appropriate, the patient is better, the care costs less, and the family understands the plan with good communication because they are part of the team.  Can you imagine the provider satisfaction as well? The doctors are working towards the improved health of their patient as quickly and efficiently as possible.  Less physician burnout as there is less conflict at work.  Everyone wins, especially the patient.

Sheilah Snyder is a pediatric hospitalist.

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