Tuesday, September 12, 2006

Relationship

In a comment on my previous post, ex utero said something that I completely agree with. Discussing meeting parents, the good doctor said "I also try and talk to parents whenever I see them at the bedside..." I try to do the same thing, even if their baby is doing fine and there's nothing exciting going on. You can always find something to say, like their baby is growing well, or we're going to start nipple feeding the baby soon, or how handsome their kid is. Many parents don't really know what to ask, so I like to give an idea of our plans for the coming days, even if it is just to feed the little guy and make him grow.

It's a small thing, but parents really seem to appreciate it. Regrettably, I didn't realize this at the beginning of my neonatal career. I didn't much enjoy talking to parents then, although I'm not sure why. Now I find it very enjoyable to get to know the parents and have them like you and trust you. I also find that if you have to call parents to give them bad news, it goes much better if you've developed a relationship with them and they not only know who you are when you call them, they actually have confidence in you.

I think, though, that some parents don't realize that building a relationship is a two way street. Although the main onus of developing a good relationship with parents is on the physician, the parents will have a better relationship if they do their part, too. One of the most important things for parents to do is to actually show up to visit sometimes. It's especially helpful if they show up at a time when the doctors can talk to them. I like it when parents are there during rounds, so they can hear the same information we do about their baby and hear the plan. If they can't be there then, it's nice if they can be there sometime during the day so I can chat with them when I wander through the unit in the afternoon.

Some parents , of course, can't make it during the day, because of work or transportation issues, and only come in the evening. The unfortunate truth is that those parents just don't get the same attention that daytime parents get. They have to rely on the night duty physician, as opposed to the physician doing the daily rounds, to talk to them. Some night physicians do it well, some do not. Here parents can take some of the initiative in building a relationship. I think it's great when a parent who I haven't seen much calls to say they just want an update on their baby. Unfortunately, that rarely happens. (Why? Are we doctors that intimidating? Or don't they care about their babies? [I think they do.] Or are they just not aware they can do such a thing?)

As I think about it, I realize there can be all kinds of nuances in parent - physician relationships. Maybe we can talk about it more later, but for now I've got to go cook supper.

17 Comments:

Anonymous Anonymous said...

You are right, relationships are a two way street. As a parent, I try to be respectful of a physician's time. One of the things that I find helpful is to keep a spiral notebook for each year for Dear Son. In this notebook, I write down each hospitalization, office visit, conversation with the insurance company, etc., etc. For hospital visits, I write my questions down and then ask them during rounds. If I am not available for rounds, then I will ask them to let the doc know that I have some questions and give them my availability so that I can get them resolved. As a parent, I also think you have a responsibility to ask questions during the hospital visit, so that you know and understand the care plan and what they are doing. Outside the hospital, I think it’s important to educate yourself on your child’s condition so that you can ask appropriate questions.

For office visits, I do the same thing. I write down each office visit date and any questions that I might have, prior to the visit, so that when the visit arrives, I can ask him about these items and not waste any time. I also ask them how they prefer to be contacted (phone call, pager, e-mail, home phone). It helps me too when they leave a message, to indicate how I should return that call; do they want me to call them directly, call their nurse, page them, etc. I tend to prefer e-mail when it's not urgent or when I need several prescriptions, letters of medical necessity, etc. On the last page of the spiral, I write the date, blood pressure and weight of Dear Son on that day. It helps in case of an emergency, to know what his normal BP is or his last weight when it might be difficult to get a weight during that time. I have found this to be a good system.

In my professional life as a Relationship Manager (Account Manager) I always found it beneficial to establish a good relationship with my clients. Part of that entailed discussing their expectations and communication style preferences on the initial visit. Once you have a good relationship with someone, it's much easier to deliver bad news/outcome and to resolve that item while still preserving the relationship.

6:01 PM  
Anonymous Anonymous said...

A lot depends on the patient population you serve. As a parent, it can be frustrating for parents in the unit to speak to different people everyday. I usually tell them that I am going to be your primary physician for the next 2 weeks or 4 weeks, and before I leave service, I try to introduce them to the doc coming on service.
There are parents who are there night and day....I have seen parents who have lost their jobs because they took too much time off to be with the baby.
Then obviously, you will have those parents who want everything done for the kid, but dont have time to visit. How does it matter when the state is footing the bill?
Anyways, I think comfort talking to parents also comes with age and experience. When you have confidence in yourself, it rubs off on the patients as well!

7:41 PM  
Anonymous Anonymous said...

Thankfully the neonatologist who actually took care of my son for two months was wonderful. But in my first pregnancy with my daughter, while on hospitalized bedrest at 28 weeks, the neo. who came to talk to me was the coldest dr. I have ever encountered. He stood by the door while explaining the complications associated with delivery at that gestation, and although I was trying very hard not to cry, I couldn't help it. He never came closer than 5 feet away from the bed. I think that if a dr. doesn't want to deal with parents, he should probably choose another specialty.

8:57 PM  
Blogger Ex Utero said...

It is easier to bond with some parents than others. There really are some parents who just don't visit. They call, usually every day, ask appropriate questions, but their basic attitude is I'll take over when the child needs a parent - you're in charge while they need a doctor. And I have to say, some of those parents are fantastic in follow up clinic. I think some parents just don't like the NICU and don't want to be there.

One thing about neonatology is that it really helps to be good with parents. It's not a popularity contest, but people who have a hard time communicating generally have a hard time in this job.

10:03 PM  
Anonymous Anonymous said...

I just have to add my 2 cents. In the past two weeks we took our medically fragile child to see two different specialists for routine (ongoing) followups. The first was fairly new to the hospital, the other had been in practice there for over 20 years.

I gave the first doc a photo of my child. She looked at it without comment and set it down. At the end of the visit, I noticed she had left the photo on the counter after she left. Somewhat disappointed, I put the photo in my handbag.

The following week, while waiting (1 1/2 hours) for the other specialist, I pulled out the photo. I offered it to the doc at the end of the visit. He accepted it with enthusiasm; wrote my child’s name and the date on the back and placed it into his file.

Such a simple thing, yet what a difference in approach.

So the moral to all you docs, when offered a photo, please accept it with a smile.

10:12 PM  
Anonymous Krystal said...

When my daughter was in NICU, I only requested to speak to the neo two times I think. I thought it was more the nurses' job to inform me of my daughter's updates. I was there every day, multiple times a day, many times when the neo was there, but he only approached me on his own a couple of times. I felt like he must have had a lot on his plate, so I relied heavily on the nurses. They never failed me (until they threw away my milk supply from the freezer before I could come back with a freezer tote to retrieve it after discharge, but that is beside the point) and I never really felt neglected by the neo either. I would bet some parents you encounter feel a lot of respect for you and what you do and therefore only contact you when a nurse cannot answer their question or supply them with the info they want.

10:42 PM  
Blogger PaedsRN said...

I'm not a natural conversationalist. I find I really have to work at it, though I tend to use humour a lot which eases the tension. I really envy some nurses who can just sit there and chat away all day, finding out all sorts about the Mum and Dad, their extended family, where they grew up, what they had for breakfast...

Some parents definitely make it easier, for sure.

6:16 AM  
Blogger Flea said...

What's for dinner?

It's a commonplace to say that some parents are easier to talk with than others.

And it's a commonplace that if the parents don't show up, you can't very well have a face-to-face.

best,

Flea

8:30 AM  
Blogger The Pajama Mama said...

It is a two way street. I was very grateful for the talkative physicians my daughter had when she was in the PICU with double pneumonia, croupe AND RSV. They made my day. It gets lonely sitting there with nothing to do but watch your sick baby sleep and struggle to breath.

8:51 AM  
Blogger WendyLou said...

In the NICU that dd was in, there was not a set time for rounds. One doc usually rounded at 9, and I was usually there, one around 12, and I usually talked to her on the phone, and the other rounded whenever and rarely called.

I felt, likely because I saw him with DD, that the 9am doc gave her the best care. He laughed with me, and DD spit up on him. He often said, "I could just play a tape for you, nothing new. Countinue weights, feedings, etc. Check a crit on Sunday." HOWEVER, when he came to me and said DD needed a transfusion, I was able to listen calmly to him and felt ok with the transfusion.

I always felt with the other docs they were to busy/important. Then I learned how much they were getting paid a day for her care, and I then wrote on her chart, Parents request at minimium phone contact on a daily basis. Phone call usually took about a minute and a half, unless we had questions.

Even if there is nothing new, just knowing that there is nothing new, is important.

I'll tell you, physician attitude is huge. One peri discussed termination possibilities with us. After being told there was no way, he then proceded to lecture us on Utah law. Another doctor, discussed with us why an amnio was important, and what we could do with that information, namely take no heroic measures, and avoid a classical c section. His discussion was much better recieved.

I love seeing DD's picture on the wall in the OB's office.

11:59 AM  
Blogger karrvakarela said...

I went to my kid brother's school the other day to help him buy his uniform. In the store, along with all the other kids, was a child I had taught several years ago, in my second year holidays from med school. She was in high school now. I almost didn't recognise her but when I did, it was a pleasure to see her all grown up. And by coincidence, her mother was a pediatrician I'd worked with that same summer!

That's what I love about pediatrics, the evolving relationships we have with the children as they grow up.

1:07 PM  
Anonymous Anonymous said...

I always enjoyed seeing our neo each day when I was still off of work. When I had to return to work, I called each day and got an update from the nurse.

I found that leaving my questions on a piece of paper for the doc was helpful, too. The neo would "scrall" an answer, and the nurse would interpret. It was kind of fun trying to figure out what he wrote. It helped make the long hours in NICU a little light hearted.

I'm not a big talker, but face-to-face is better for me because I can see facial expressions, hear tones, and read body language. I always knew when my peanut was in crisis just by looking at the frown on the neo's face.

Yes, sometimes docs are hard to get to know, but others aren't. I suppose it is that way in any profession.

A proud 2 X NICU Mom

2:28 PM  
Blogger Awesome Mom said...

Well your hospital must be different than the NICUs that I have encountered because parents were kicked out of the NICU during rounds and shift change due to patient confidentality. I found that very irritating and frustrating. I like that when my toddler is in the PICU the doctors round going from room to room. I make it a point to be there because I can add to the conversation and I get to know what the goals for the day are and what tests are coming up.

The few times I do go home I don't bother to call because I have had many satisfactory calls. One time I called and was told that everything was super. I go back to the hospital later that day and my sod had an NG tube placed because he had not been eating well. I was very upset that I had not been informed that there was a problem. I would much rather be there than rely on a rushed phone call for my information.

3:41 PM  
Anonymous Sammy's mom said...

In my son's NICU, rounds started at 8am following shift change, and they started with the most critical babies first. For weeks on end, my son was typically first or second. What a relief when the docs were rounding at his bedside at 11am! We visited multiple times each day, but when we couldn't be there for rounds, the nurse always located the doc immediately upon our arrival so the doc could come and give us a daily update. There's nothing better than to see the neo walking down the aisle toward you with a smile on his/her face!

I spent as much time at the NICU as I could, and anytime a doctor called me at home, it practically made my heart stop beating in fear! If a doctor called me a home, it was not good news.

9:42 PM  
Blogger Fat Doctor said...

It drove me bonkers when the neonatologist kicked us out of the room so he could round with the residents. BONKERS. I think he was scared of me. I can be scary when it comes to protecting my kid.

10:24 PM  
Blogger neonataldoc said...

Dream mom, you are absolutely right about writing questions down. I do the same thing when I go to my own physician. (Why are you commenting anonymously?)

Some parents, certainly, are easier to get to know. Just like in regular life, some people have personalities more like us and some are different. Paedsrn, I used to feel the same way as you. I'm not sure what changed, but now it's easy to talk to most parents.

Regarding the presence of parents during rounds: a good topic; I'll save my comments for a future post.

10:07 AM  
Anonymous Anonymous said...

I commented anonymously because I had to attend to Dear Son and it was faster. I don't have much patience and the beta blogger requires I sign in whereas the old blogger did not. Besides, you're smart, you could figure it out:)

Dream Mom

6:13 PM  

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