Monday, January 20, 2014

trust but verify

(This post was inspired by, but not directly related to, Mandi's post over at Messy Wife, Blessed Life.) 

Pediatricians and parents are in a partnership when it comes to the health of children. I would venture to say neither one is the ultimate boss in the partnership-- parents of course have the final say in many things, but not if their decision will cause blatant harm to their child (e.g. refusing oxygen for a previously healthy child with pneumonia, or insisting on feeding a preemie whose intestines aren't mature enough).  They each have different roles.  Parents know more about their child, and pediatricians know more about medicine.  (That's not meant to be an insult; it's just a statement of fact. Lawyers know more about law. Literature professors know more about literature. Statisticians know more about statistics.  Why even go to a doctor if they don't know more than you about medicine?)

Sometimes-- not often, but sometimes-- parents will get very defensive and upset if their pediatrician wants to check something that the parent doesn't feel is a problem.  "What about our partnership?!" they're thinking.  "Why don't you trust me?  Do you think I'm irresponsible? Do you think I don't know what I'm talking about?"

It's not that we, the pediatricians, don't trust you, the parents.  But we don't really know you that well-- certainly not well enough to say "they would NEVER do that."  And we've seen so many bad things happen to kids, even kids whose parents seem trustworthy.  Toddlers who were shaken until they bled into their brains.  Babies who developed herpes meningitis despite their moms' insistence that they couldn't possibly have herpes. Preschoolers whose teeth have literally rotted away because their parents didn't bother to brush them or take them to the dentist.  Kids who fractured their skulls in car accidents because they weren't buckled in properly.  Ex-preemies who became severely anemic because their parents didn't give them iron supplements.  3-year-olds who don't know how to talk because their parents didn't realize that was a problem and didn't take them to their check-ups.  Kids who ended up on ventilators because their parents didn't give them their asthma medications.  I could go on and on.  Pediatrics is usually a happy field of medicine, but when it's sad, it's REALLY sad.

So we worry.  We worry about the newborn whose mom declined prenatal HIV testing, because we don't know her from Adam (or Eve), and maybe SHE knows she can't possibly have HIV, but WE don't know.  We worry about the slightly-underweight child who missed his follow up for a weight check, because probably his parents are feeding him a perfectly normal diet, but what if there's something wrong?  It's not that we don't trust our patients' parents, but stranger things have happened, and we've been wrong about people before.

Now, obviously there is healthy skepticism and concern, and then there is blatant patronizing rudeness.  But if you find yourself asking, "Why doesn't she trust me?" about a pediatrician you otherwise like, give her the benefit of the doubt.  It's not that she doesn't believe you, she just wants to be sure because she cares about your child.  As one of my adolescent medicine attendings used to say, "Trust but verify."  (Now, she was usually talking about whether or not to run STD tests on teenage girls with pelvic pain who swore up and down they'd never had sex-- and whaddaya know, some of them had chlamydia-- but the point still stands.)

Think about it this way:  if your child got hurt while being cared for by your babysitter, you'd want to hear your child's version of how it happened, right?  That doesn't mean you don't trust the babysitter.  You just want to be sure.  (Obviously I'm not saying parents are to pediatricians as babysitters are to parents-- it's not a perfect analogy, just another "trust but verify" example.)

And of course, "trust but verify" works the other direction too. You're perfectly justified in wanting to double-check that what your pediatrician says is accurate, and any doctor who isn't willing or able to explain his or her reasoning is not a good doctor.  (Though please, I beg you, make sure you're using a reputable source when you double-check-- not Dr. Google or your Facebook friends. For a good explanation of what makes scientific literature valid and "peer reviewed," read this.  This article/post is specifically about vaccines-- which I'm not going to go into, but I'm sure you can guess where I stand-- but the part about peer-review applies to anything.)

If you feel like your pediatrician never listens to you, then it's time to find a new pediatrician.  But if he sometimes apologetically wants to "make sure" of something, and you're wondering whether or not to feel offended, put yourself in his shoes.  Most parents are good parents, but some aren't, and it's sometimes hard to tell the difference in a 15-minute appointment. 

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