As is the case throughout the country, central Ohio is in the midst of a viral surge with an unusually high number of ill children for this time of the year, leading to long delays in our urgent cares and emergency departments, in our primary care offices, and with over capacity inpatient units. It’s an extremely busy time for all of us and honestly makes for tiring and stressful days. However, this is the current situation and will be the case in the near future, so I thought it would be a good time to share some advice I have learned from several esteemed mentors in my 30+ years in pediatrics. Here goes:
1. “They are there because they care.” As one of my ER faculty would say during residency. The vast majority of parents truly love their children and want what is best for them, including waiting six or more hours in the ER to have their sick child evaluated. They don’t come in because there is nothing better for them to do on a fall day but because there is a true concern on their part that something is wrong. Acknowledge that.
2. “Fear drives all of us. It’s part of being human.” As another ER faculty would state to us. Direct-to-consumer pharmaceutical advertising lives off of this premise (“Ask your doctor if you may have xyz condition …”), and while a healthy fear drives learning, an unhealthy one makes people do what seems unreasonable. I am not a gearhead, so when one of the warning lights goes off in my car or the car makes an unusual noise, I fear the worst. Nearly every time, it is something simple (air in tires is a good idea) but the entire ride home I am convinced that the car and I will blow up or just stop working on a busy highway. Yes, irrational, but it’s a human response to a topic that one does not know well. Now imagine the parents who have heard the news report after news report talking about how deadly the flu may be this year or about the unexpectedly high RSV rates. They are afraid, and since they truly care, they want you (the expert) to reassure them that things are OK.
3. “Humanize and apologize.” Learned this day one intern year from my favorite attending of all time. After waiting for many hours with a sick child PLUS with their very active, very bored, very hungry, and now completely lost it siblings, parents are frustrated and at wit’s end. Apologize for the wait, thank them for caring enough to wait to be seen, and acknowledge their fears. But also treat them with dignity. Ask the siblings about what costume they wore on Halloween. Ask the family what language they were speaking (I see a large number of immigrants) when you walked in. Ask them about their favorite fall leaf color. It takes mere seconds, but it takes you from being a technician servicing a car to a human being taking care of a child and family.
4. “Use every opportunity to empower patients and families with knowledge.” From one of my fellowship attendings. Saying to a family, “it’s just a virus, so don’t worry,” is probably OK. However, it is much more powerful to say: “It’s a virus, and here is why. However, I want you to look out for the following red flags that mean that junior needs to be seen again.” Now the family has been empowered with knowing how to monitor their child’s health, and instead of just being in the hands of the viral fates, they are now steering the ship.
5. “Hello, we are stressed out as well.” From the lead nurse at a pediatric ER where I moonlit a lot early in my career. While we tend to focus on ourselves when feeling overwhelmed, remember that your colleagues are as well. One of the nurses in the urgent care where I was working recently made it a point to ask every person there at least once how they were doing. It took seconds but just knowing that someone was looking out for me and also working over capacity made a huge difference. Try asking your colleagues the same. Thank the suture tech for a nice job with a tough-to-sew wound. Thank the nurses for grabbing that extra set of vitals on the child getting his second back-to-back neb before you even asked for it. Small tokens of appreciation take a group of technicians in the same room and make them a team working together to help others
6. “We are trainees and need to learn.” Just heard this from our amazing group of chief residents. Like probably everyone else, when it gets busy, I put my head down, stay quiet (which is unusual for me) and just plow through the work. The short formal lectures that I love to give usually go bye-bye. Yes, residents learn best by seeing and learning with experience. But they need teaching. Even a short 30-second “let me see you do a hip exam on this baby” or “let me show you a rash, and you tell me what you think it is” can turn the busy clinic back into a teaching clinic. Spot teaching is an art that we can all practice getting better at, but it is so vital to do.
7. “Honey, it’s just a phase, so this too shall pass.” From my wife, with whom I have been blessed and honored to raise seven children. From the screaming infant to the easily angered toddler to the moody teenager, we have seen it all, with my wife so much better at handling this. Why? Because she is great at seeing things big picture. That cranky toddler was recently a happy, smiling blubber of an infant and will soon be happy, exploring, and talking preschooler. Just ride it out. Yes, this has probably been the busiest fall I can remember in my 30+ years of doing this, but this too shall pass (regardless of what Gandalf says).
Yes, it’s busy, but this too shall pass, and it will hopefully be easier to deal with the stress taking into account some of these suggestions.
Alexander Rakowsky is a pediatrician.
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