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August 2007
Pediatrician vs Parent Perspectives
Communication Is Key

by Michele Bush Kimball

Bethany Little knew her 6-month-old son’s rash was out of the ordinary. It was painful, red, persistent. Nothing she did would make it go away. She did some research on the Internet and suspected her son had scabies, an itchy skin condition caused by mites that burrow under the outer layer of the skin.

When Little, who lives in the Northwest section of Washington, D.C., took her son back to the pediatrician, she was told he had a virus. Little questioned the diagnosis and suggested it might be scabies. Her pediatrician said it wasn’t. Little said she didn’t want to believe her son had scabies, so she went against her gut feeling and agreed.

The treatments her pediatrician recommended didn’t work, so Little took her son back. Again, she mentioned that she thought her son had scabies. Again, she was rebuffed. At that point, she asked to be referred to a specialist.

The specialist took one look at her son and confirmed Little’s suspicions.

"The child had scabies," Little said, exasperated.

Eventually, Little left the pediatrician and took her son to another practice. "It’s a bad thing when you are fighting your own pediatrician," Little said. The lesson she learned from her experience was to trust her judgment when it comes to her son’s medical care. "It’s so cliché until it happens to you," Little said, "but believe your gut."

Disagreeing with a pediatrician can be frustrating, but there are ways to ensure that the lines of communication between parent and doctor remain clear.

Devra Renner, coauthor of the book Mommy Guilt, said most pediatricians have the same goal for their patients as parents do: healthy children. She recommends parents advocate for their children’s health while still remembering that pediatricians are human.

Renner has had her own experience in disagreeing with a pediatrician. Her son had been ill for a few days with what Renner thought was croup. He had been unable to sleep for a few nights because he was coughing so much. When the over-the-counter medications didn’t work and she started to hear a wheeze in his cough, Renner took him to the pediatrician.

The pediatrician said the illness would clear up eventually, and there was nothing medically to do to help. Renner told the pediatrician she disagreed with her diagnosis and took her son to another doctor that same day. The second doctor’s diagnosis was pneumonia. Renner ended up leaving the first pediatrician and staying with the second one.

"What I have found over the years is that you see doctors, and there are some you gel with right away and some you have to work with on the relationship," Renner said.

Her experience taught her to find the pediatrician that suits the needs of her family and communicates in a way that is effective for both parties. Renner said she also recommends looking at the experience as a whole with a particular practice. Analyze experiences with other partners in the practice. See if there are other pediatricians that may be better suited to the family.

"A disagreement with a pediatrician doesn’t mean you have to switch," Renner said. She also works hard to recognize that pediatricians are dealing with sick children all day long, which may wear on them.

"You know what? Doctors are only human," she said. "They have bad days, too."

Pediatricians’ Perspectives

Dr. Tomas Silber, a pediatrician at Children’s National Medical Center and the head of the ethics committee at the hospital, said that disagreements between parents and pediatricians center around a variety of issues. Two of the more common ones are immunizations and the use of antibiotics.

"Sometimes the physicians are right, and sometimes the parents are right. It happens all the time." The key to working through the disagreements is communication. Both parties have to understand the medical situation at hand and come to a conclusion that best serves the needs of the child, he said.

"The doctor and parent have an obligation to be civil and clear and explanatory with each other," Renner said.

Silber said it is important to recognize that when the doctor is treating a medical emergency, there is less time for discussion and explanation. When there is a disagreement between parents and pediatricians, both parties need to be clear about the seriousness of the child’s condition, coupled with the intensity of the disagreement. When there is time, and parents disagree with the diagnosis or treatment, Silber said he recommends getting a second opinion.

He said he also recommends that parents communicate their fears to their child’s doctor. Doing so helps the doctor understand what issues should be addressed right away to put the parents at ease. "If the parents don’t share that fear and anxiety, then they will be in two different worlds," Silber said.

Dr. Bill Ohriner, a pediatrician at Inova Fair Oaks Hospital, also said that the most common disagreements between parents and pediatricians stem from the use of immunizations and antibiotics. He spends quite a bit of his time during office visits just talking with parents, which helps both parties best understand each other and their goals for the patient. When a parent is unsure or unhappy, Ohriner said, it is a priority to get the issue clarified.

If a parent is still unsure about a diagnosis or treatment, and the medical situation is not an emergency, Ohriner strongly recommends getting a second opinion. He said he either sends patients to other pediatricians in the practice or he helps them find other doctors to see.

"We have no qualms sending people off," Ohriner said. It is important for parents to feel they have all of the information necessary to make sound medical decisions for their children. In the end, however, he said parents have to feel they are being heard and all of their fears and questions are being answered. If parents are feeling unsatisfied in those areas, Ohriner suggests switching to another doctor. "If you feel like you are getting blown off, and they are not listening to you, I think it’s time to get a new pediatrician."

It is important to find a pediatrician who fits a patient’s life and choices, he said.

Ohriner’s wife, Dr. Jamie Ohriner, works as a pediatric hospitalist at Inova Fair Oaks Hospital. A hospitalist is a doctor who works specifically with hospitalized patients, rather than with patients at general office visits. Therefore, she is more often involved in medical issues of a higher magnitude, such as emergency situations or medical testing and procedures in the hospital.

She said it is rare for the parents of patients with whom she works to refuse treatment, but they might disagree with treatment. In those cases, when it is not an emergency situation, she also recommends getting a second opinion from another doctor. "I have no trouble if someone wants another opinion. I will respect the parent’s right. My job is to give as much information as possible."

To help parents process all of the information they need to understand their child’s care, Jamie Ohriner said she provides as much as she can in a written packet. Getting the information in writing helps the parents have a resource to which they can refer when questions arise. She also encourages the parents of her patients, when there is time, to write down as many questions as come to mind, so they are sure they are getting all of the information they need. Parents are the final arbiters of a child’s health care.

"They are the advocates for the child in the hospital," she said. "We would never do anything that the parent absolutely did not want for their child." The medical decisions being made on a young patient’s behalf should be a partnership between the parent and the doctor. She said it is the doctor’s job to provide as much information as possible to the parent and patient to help them through medical procedures.

"We do our best to make them feel comfortable with the decisions they’re making," Jamie Ohriner said.

Michele Bush Kimball is a freelance writer based in Springfield. She is a stay-at-home mom to a 4-year-old boy and a 2 1/2-year-old girl.

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