I recently had the chance to shadow New York pediatrician Dr. Barney Softness as he cared for young patients and talked with parents. I asked Dr. Softness (yes, that's his real name) to share his thoughts about the mistakes parents make when they visit. -- Tara Parker-Pope
By Barney Softness, M.D.
Recently, a mother and her nervous toddler were waiting for me in my office. To reassure the child, the mother promised her there wouldn't be any needles used during the visit. ``Right, Dr. Barney? No needles?''
At that point, I hadn't even examined the child. I didn't know what was wrong with her and had no way of knowing if she might need a blood test. ``That all depends on what is wrong with her,'' I told the mother, who quickly scowled her disapproval, and the child erupted in protests.
Parents are an essential part of their children's health care. Even though pediatricians are trained to treat children, we rely on parents' instincts about their child's health and their ability to comfort a child during an exam. Knowing what to say and what not to say can make the experience better for everyone, especially the child.
Yet well-meaning parents, who are really trying to make things as comfortable as possible for their child, can sometimes end up doing the exact opposite. Here are some examples.
Don't make promises you may not be able to keep. While parents will want to reassure a child who is afraid of needles, it is far worse to make a promise the doctor cannot keep. Then you have lost trust. I may look at the child's record and discover she is due for a vaccination. A promise of no needles would mean coming back another time -- and the anticipation of coming back for a shot prolongs the agony. Focus on the positives when you are trying to reassure your child about a doctor visit -- a favorite toy in the waiting room, the stickers we give at the end of the visit, or the trip to the playground after the appointment.
Don't try to trick kids. Sometimes parents tell a child he is coming along just to accompany his brother to the doctor, and then surprise him with an exam as well. Even if it's a harmless ear check, it may not seem so to the child, and he won't fall for that one again. And he won't trust you -- or me -- next time.
We're not the bad guys. You'd be surprised how often I hear the phrase: ``Here comes the mean doctor (or nurse).'' We do sometimes have to do things that are painful or uncomfortable, but it does not do the child any good to portray us as mean or evil. It makes our job more difficult, and it makes the child think you're not doing a very good job protecting her if you're allowing us to do the dirty work. You know it hurts, but we are helping your child, and that is the message you should try to convey.
Don't sugarcoat too much. You may think that a doctor's stethoscope on your chest is not much of an issue. But if a toddler is screaming about it, it is to him. Telling him that this doesn't hurt, or is even fun, doesn't legitimize his feelings. And further, if he's just learning the language, the next time you tell him you're going to the playground to have some fun, he may get the wrong idea.
Don't tell me your diagnosis. Often parents come in to rule out a single ailment -- such as Lyme disease or diabetes. Or they tell me they think their child has another sinus infection or strep throat. They mean well and usually are worried because someone -- or often a Web site -- told them their child's symptoms match a particular problem. But, an accurate description of symptoms is much more valuable. As doctors, we don't presume a sore throat is always strep or frequent urination is always diabetes. It could be any number of things. However, if you have a specific reason to suspect a particular condition (for example, her brother has Lyme disease), it may help in the analysis.
There's no such thing as a quickie. Squeezing two kids into one appointment isn't good for your kids, and it's not fair to the other children in the waiting room. Too often parents will bring a sibling along and ask me to ``just check his chest real quick.'' But even when the quick exam is normal, it often leads to follow-up questions about what else could be wrong. Each child deserves my full attention.
Let your kids take part in sensitive conversations. There are obviously certain discussions that need to be conducted out of earshot of the child -- divorce, unemployment or the parent's health come immediately to mind. But many times parents don't want to embarrass their children by discussing other sensitive subjects in front of them, like bedwetting, constipation, weight or poor school performance. Sometimes an entire visit is merely a pretense for the real concern, which the parent finally brings up after a child has left the room. But your child already knows the problem!
Having a parent transmit my advice to the child doesn't work nearly as well as when the child is involved in the original discussion. If the discussion is handled in a professional matter-of-fact manner, you can almost hear the sigh of relief. (Even if the child makes no eye contact during the conversation, they are definitely listening.) It is never as embarrassing as parents expect it to be.
Dr. Softness is a general pediatrician in Manhattan as well as a pediatric endocrinologist and diabetes specialist. He is on the faculty of Columbia University's College of Physicians and Surgeons. Tara Parker-Pope is on vacation.
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Not sure I agree with this. What is wrong with telling a doc what you suspect? Maybe you will be wrong, but isn't that part of the information gathering process?
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
Good article! Amazing that he mentioned Lyme at all.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
My children's pediatrician used her good ol' CDC handbook
To "accurately" dismiss my child of TBD's.
Even while holding an Igenex Western Blot in her hand
And given a huge list of symptoms.
Her response. "Oh all kids her age complain of those things".
Wonder how many parents she isn't listening to....
Good article though. I always give symptoms and then ask questions.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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map1131
Frequent Contributor (5K+ posts)
Member # 2022
posted
Good article. I completely understand the doctor's point of view on things. I always go with a list of things to my doctor appt.
If I don't make a list, no telling what I'm going to forget to talk to him about. But if any doctor pulled out the CDC book to dx me or my grandchildren I would go ballistic.
My grandson that I'm so worried about the last several months, really needs to have me with the parents during a peditrician visit. I have a Igenex kit just sitting in my closet waiting for someone (Mom & Dad) to face facts.
All I want is 5 minutes with the peditrician alone to explain my briefest history of 10 yrs with lyme & company. To explain that this child is a bug magnet just like myself.
It doesn't matter if he has deet on neck to toes, he will be attacked and biten by many unknows out playing or walking in the yard.
His reaction to these "bug" bites are always days and days to heal. If same night him & brother are bitten, the oldest will still have signs of bites and whelps on his body long after his brother.
An spider bite in Oct turned into a strep/staph ordeal. If I was the parent, he would of gone to the doctor. But I treated him myself with peroxide and anti-ointments and drawing out the infection.
His school was concerned enough about the under the chin bite and infection to make him wear a band-aid for about 6 days when ever he was around other children.
I saw the deer/nymph tick. I lost it during removal. It had been on his neck for a couple days.
Both parents know there's a problem with this child's health. Both know the school has suggested ADHD treatment. His K teacher and his 1st grade teacher have compared notes on this child and he is not the same child.
He's told me many times, that he has told the teacher he is ill and the teacher just ignores him. Sure enough if I look at his throat, it's red and inflamed. Sure enough he will have a temp. that can go up and down.
I've been keeping notes on things he says to me for months. I see him off the school bus and watch him for one hour 3-4 days a week.
We just talk, do an after school snack or watch a movie. But I make it a point to ask him to tell me about his day at school. His behavior is an issue due to interuption and disruption in class.
He always tells me he can't help it when he makes noises, yells out, fidgety in his seat, reading and comprehension is a bad mark for him.
I know this child. He's telling me the truth. I just don't know what to do. Mom and Dad are still in denial stage. Until something happens like out of no where the child starts complaining about this horrible ringing sound in his ears. It goes on and on. Oh, it's gone the next day. He's okay.
They think it was a freak accident what happened to me. I don't know where to turn???? It makes me sad.
Pam
-------------------- "Never, never, never, never, never give up" Winston Churchill Posts: 6495 | From Louisville, Ky | Registered: Jan 2002
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bettyg
Unregistered
posted
lou, outstanding find for parents with lyme kids!
i didn't see lyme mentioned in there at all...
lou, any possibilities you could break up the 3-4 EXTRA long paragraphs to help us not miss anything important. i can't send you a pm as i was going to do.
thanks for your consideration! this will help parents tremendously!
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tailz
Unregistered
posted
I guess I'm the oddball again. What I got from this pediatrician's message was - parents are expected to instill in their children (early on) that doctors are their friend and trying to help, even when the child's own instincts are telling them otherwise.
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I have 2 children, my oldest is about to be 5 and youngest 17mons.
When I took my son to get his vaccinations I actually told him that it is going to hurt.
It almost became a game just before the shots, while we were in the waiting room. We had a mini yelling competition, dont worry I didnt let it get out of hand.
I told him "it is going to hurt, so I want you to yell, ok?"
Then he asked me how bad, and I told him it will hurt real bad but only for a second or two and it will be kinda sore for a while.
He asked me " am I going to cry?" and I told him he can if he wants to. But when he does cry he has to be really loud, this way he can scare the pain away.
He laughed, and we went in. He wasnt any less scared, but he was ready and willing to get on the table for the shots.
As the nurse got ready to give the shot I looked at him and said "are you ready, take a deep breath and then scream," The nurse stuck him and he half cringed and half giggled.
It was like there was soo much building up to him screaming that when it came time to scream he laughed.
I Said "what happened? You were supposed to scream? He said it didnt hurt me bad, and you made me laugh".
I thought it was a cute story to share.
-------------------- PROUD : )
Dx: Lyme & Bart April 2008. currently on plaquanil, Roxid and Sulfameth. Posts: 89 | From Manalapan, NJ | Registered: Feb 2008
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