Monday, December 27, 2010

Are you a Difficult Parent?

A recent article in Pediatrics examines how pediatricians can manage their relationships with "difficult" patients and parents - those who are clingy, demanding, manipulative, or self-destructive ("Approaches to the Difficult Patient/Parent Encounter").

A litigious father, for example, complains angrily about the diagnosis for his 7-year-old son. A 15-year-old girl constantly challenges her pediatrician's advice. "Patient/parent issues can include psychiatric disorders, personality disorders, subclinical behavior traits, and information overload," the authors write. These patients and parents are no doubt difficult to handle.

But then the authors write that
Parents of children with chronic illnesses may be considered challenging; these parents are vulnerable or even frantic because they are coping day after day with an ill child. Despite recent clinical advances, many chronic diseases cause great suffering and uncertainty.
And I started to wonder whether some doctors simply had compassion fatigue. Often, it seems, patients (or their parents) are difficult because they don't think they are being heard or understood. Sometimes, being a good parent and means being a good advocate for your child's well-being - and therefore being difficult. 

Studies have shown, for example, that the most common type of medical error, medication mistakes, are especially common among pediatric patients. I've written before about radiation overdoses from CT scans that are not calibrated appropriately for children. Parents need to understand these problems and ask questions when their children need a medication or procedure. If they don't understand the answers, they need to ask more questions until they do - no matter how busy the doctor or nurse might be.

And so for 2011, I'm sending out good thoughts to all the parents out there. I hope they ask questions, get the answers they need, and participate actively in their children's health, in the doctor's office and at home. Because if your kids are doing well, you don't need much more than that.

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