How the pandemic can bring the family-centered model back to pediatrics

The devastation inflicted by the coronavirus pandemic both in terms of health and the world economy will continue to be discussed for quite some time. Large numbers of our neighbors have been impacted in these ways. What has also been just as profound is how this pandemic has changed relationships. Corona has greatly impacted our ability to interact in ways that we can all relate to: social isolation, wearing masks, not being able to go to work or school, not having loved ones with you if you need to seek urgent medical care, losing the ability to publically express one’s faith in places of worship and so many other examples. It is human nature for us to form relationships, and the pandemic has painfully limited our ability to do so.  

This pandemic has also made many families reconsider just what healthcare means to them. Are those yearly physicals really needed, and if so, can they be done more conveniently at the local minute clinic? Can I save time on my child’s regular visits for his/her chronic illness by choosing telehealth or email rather than in-person visits?  Is it even important to establish a relationship with my child’s pediatrician if he/she always seems to be rushing us in and out in the first place? These were important issues before this pandemic but have definitely been augmented as families have had their lives changed dramatically because of it. It is vital that we take this opportunity as a specialty to truly show our patients and families that the care we provide is worthwhile. There is no better way to do this than to focus on what human nature already motivates us to do: build relationships. 

We already know that the new logistics regarding the way we practice medicine will take some time to iron out. Telehealth visits might become more widespread as well as weekend and evening hours to accommodate families that will be forced to work more to make up for lost wages. The logistics will definitely be a work in progress. But what can we pediatric providers do now? We list some practical suggestions that any of us can implement regardless of one’s clinical duties and setting:

1. Eye contact. For in-person visits requiring masks, it is more vital than ever to look our patients and parents in the eyes. This is as important with telehealth visits, which inherently feel impersonal. A truly gentle, caring look is indeed something that our patients and parents will appreciate (in fact, all of us would) in these uncertain times.

2. Ask the family, especially the patient, about fun things that they have started due to COVID. Examples would be family zoom meetings every week, calling distant loved ones more often, attending virtual religious services, starting a new hobby, or reading more. We all need to see the good that can come out of all of this, so let your patients express it and share yours as well to celebrate it together.

3. Ask the family and patient what impact the pandemic has had on them and truly empathize. Some people may feel embarrassed to speak about their problems, thinking that many have it worse. It is important that our patients/families know that we are all hurting to some extent during this time, and we are navigating it together. This will hopefully help build the therapeutic alliance for visits to come.  

4. Ask how you can help. We cannot be expected to have all of the needed resources, but we can provide contact information for local food banks or places to seek shelter should the need arise. Most communities have developed a list of local resources available to the myriad of corona-impacted families, so become familiar with them and have copies or links to them readily available. 

5. Talk them through the exam: With so much uncertainty about who had/has coronavirus and how it manifests, calm some nerves by emphasizing normal findings as you do the exam. Saying “your lungs are nice and clear” will alleviate more worries than our patients/families will ever let on.

6. Make sure questions are answered: Yes, our clinics, ERs, and urgent cares may return to their busier baseline soon, but it is vital that we all take those extra 1-2 minutes to make sure that families have had their concerns addressed. The patients/families come to us because they trust our expertise. Allowing them to leave with unanswered questions is the quickest way for them to lose this trust in the relationship you may have just established. 

7. Clearly summarize what was discussed and come to mutually agreed-upon next steps. This pandemic has made all of us more reliant on our abilities to fend for ourselves, so continue to empower families in this time of uncertainty. Don’t forget to follow up on these goals at the next appointment!

8. Thank them for coming in and for trusting you. Gratitude has shown through during this pandemic and one factor that shouldn’t be forgotten as being fundamental in any relationship. Share your gratitude and truly mean it. 

9. Take some time (even if just once every few months) to volunteer. Start small like helping at a local food pantry, serving meals at a local church, or doing virtual reading times that are co-sponsored by your clinic and local library. To best care for our community, we must take the opportunity to get to know it! 

10. Finally, let us not forget that old adage: Love makes a house a home. Home is where we are first loved and learn to love. We are the specialty that first promoted the concept of the medical home. Now more than ever, we have the opportunity to bring this patient and family-centered model back to pediatrics.

Gabriella Gonzales is a pediatric resident. Alexander Rakowsky is a pediatrician.

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