Many times when faced with a clinical dilemma a parent will turn to me and ask, “What would you do if this were your child?”
When faced with this question I never quite know what to say. And each time I feel a little on-the-spot. But why is that? Aren’t I comfortable recommending for someone else exactly what I would do for my own child? After all, what have I got to hide?
Here’s the problem: the decisions we make as parents involve our values, tolerance of risk, level of concern and frustration, prior health experience and religious belief to name but a few. There’s no way to fully tease those things from the parent sitting across the room.
Perhaps it’s the intensity of the fact that my child would or could be in the same situation that bothers me. When I disclose what I would do myself as a dad, it’s intimate. The decision I make for my child says a lot about me and my fears and concerns. When I disclose that I’m biasing their decision with the things that are important to me.
When I get this question, what I really hear is, “I can’t really weigh the options so help me out.” And I do. With my answer they believe that I’m telling them what I would do. But in fact it’s nothing more than an exercise to help them understand what they really want.
When I’m in an exam room I’m a pediatrician, not a father. But the art of what a great pediatrician does involves understanding the mindset of a parent. Through this understanding I can frame my recommendations in such a way helps parents make the best decisions for their kids.
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Maybe.
Sometimes, your analysis given here is dead on. Sometimes, however, we are asking for another data point. Yes, it’s my child. Yes, it’s my responsibility. And, yes, the decision should be appropriate to my values and concerns, but the decision should always be–first and foremost–what’s best for the child. Now, you can argue that “best” is a value-dependant term and that what’s best’s for my child and what’s best for your child may not be the same thing in either of our minds.
Oh, how easy it is to turn any value-based decision into a morass of mythic proportions.
Sometimes, Doc, we just want your opinion because we trust you. If you’re my pediatrician, it’s because I trust you. If I ask what you would do, it’s because I want to know what you would do. I understand that you’re not me. Odds are, I’d have follow-up questions. I’m an educated man, Doc. If I ask, “What would you do?” I’m not saying, “Please, tell me what to do.”
Yes, I understand the possible litigious ramifications. I understand that some parents actually are saying, “Tell me what to do.” I think you should be able to tease out that distinction and explain the difference where necessary.
If all else fails–if the parents sue, claiming, “He told us to do this,” it won’t matter much. Texas is a tort-reform state. Even if your advice did result in loss of life, limb, or mental faculties, the insurance company won’t be out more than a quarter-mil (assuming they can even find a lawyer to take a malpractice suit in this state).
Yes, the interests of a child always come first but often there is some latitude in the order of evaluation or therapy. Negotiation and discussion is common even when a child’s interest are held as top priority
Concerning what’s behind the ‘what would you do’ question, I think that many parents are having a hard time with the decision. They are interested in a little more of a declaration on what I think. And every parent is different. Some want more ‘direction’ than others.
I have to admit that the lawsuit question never comes to mind in this case.
As human beings, we have different roles at different times of day. It can be tricky as a pediatrician but what makes us so understanding is that we are parents. I’m a much better pediatrician since I’ve had kids than before I had kids.
If a parent asks me what I would do as a parent, I always find a way to tell them without being too intimate. Parents find that reassuring and it shows us to be human and compassionate. You can say things like “as a parent, I always try to consider….” without giving away the intimate details of your own kids’ lives.
So, perhaps instead of trying to separate your family and professional lives so much, let people in a bit more. You’ll come across more warmly and your families will appreciate you for being a great human being, and not just a great clinician.
Your right. But the balance of intimacy is easier said than done. I will say that while having kids has made me a better pediatrician I always say that having kids has made it harder for me to be a pediatrician. Bone marrow unit consults on children the same age as my own is very difficult for me.
Thanks for commenting, Gwenn
Bryan
Thoughtful post.
As the father of three girls, I have often pondered the same issues. I always try to be as clear as possible in my recommendations, and I always think about what I would do if the person in front of me was my mother, wife, or daughter.
Do you think a person who is a parent makes a better overall pediatrician than a doctor who has never had children?
I usually ask the question to make sure the doc isn’t just regurgitating the statistical evidence from the latest medical journal article but has actually thought about it from a real world perspective. Whether the question is antibiotics, a CAT scan or surgery, I’m not so much interested in where my child might end up on a probability curve but how my kid’s doc views that probability curve through the eyes of a knowledgeable parent.
I like what Dr Gwenn said, “As human beings we have different roles,” and “I’m a much better pediatrician since I’ve had kids than before I had kids.” Ditto.
When I was a resident I gave a talk and argued (from an ethics standpoint) why you should never answer the question, “If it were your child, what would you do?” for similar reasons as you point out. That single, emotionally-infused response is manipulative and diverges from aggregated data. Evidence and research helps provide reason when helping families determine what is best to do. Large studies that pool risk, outliers, and those that fall under the bell curve help normalize the “typical response.” So, answering the question as if it were your child, is like offering up a case report as opposed to a large double-blind randomized study…
But once I was a parent, and a practicing pediatrician, I started to understand why so many ask the question of me. I now have a section on my blog entitled, “If It Were My Child.” http://seattlemamadoc.seattlechildrens.org/category/if-it-were-my-child/ Parents want advice; that’s why they are seeing physicians and not looking things up on WebMD. I’m most definitely a pediatrician in the exam room, but my experiences as a mother matter, too. I understand the sense of desperation parents feel when faced with the uncertainty of disease and it’s my job to act as a scientist–but also one who understands what it feels like to be a parent.
This is a huge topic, Wendy. Thanks for your insight.