Cook Children's Experience Corner: When Patients/Parents Don't Agree
Having disagreements with patients and caregivers, while it is never fun, is an almost guaranteed occurrence in our line of work. How to handle these situations is not often taught to us overtly in our training but rather learned through a series of our own experiences, some successful and others less so. However, managing that immediate stress reaction of “fight or flight” when faced with this scenario can really make or break our chance for a therapeutic alliance.
The first and probably most important exercise is in acknowledging the difficulty in being a parent. There is much power in simple legitimization. Trying to comprehend the immense number of input streams these days from social media, 24/7 news cycles and plenty of misinformation can be overwhelming as a parent. Saying things like, “I know that being a parent can be hard, and making decisions when you aren’t sure what to do really can be scary…” can go a long way when encountering a family whose ideas differ from ours. This can be a way to open up a conversation when a patient isn’t necessarily on board with what we are saying or know to be true.
Another important aspect of relationship-centered care is asking questions to understand. Our gut instinct may be to start downloading facts/science as to why their decision may not be the “right” one. Instead, asking open ended questions with true curiosity may help elucidate the root cause of their decision making, and open an avenue for changing their mind. Asking questions such as, “In my experience, this treatment plan is usually very successful, so I want to understand some more about what is concerning you. Can you tell me a little more about why you feel that way?” In this way, we can try to put ourselves in our patient’s mind without judgment.
Lastly, focusing on building partnership is key. We don’t have to always agree but the spirit of shared decision-making means that we as health care clinicians do our best to provide the necessary information and options for treatment to allow a patient/family member to make the decision that is right for them. It is important that we create a safe space for them to feel comfortable and vulnerable enough to speak up when they don’t agree or need clarification. Reminding patients and families that their child’s safety is our number one priority, and we know it is theirs too, is important to call out. Statements such as, “I want to work together with you on a plan that you feel comfortable with, and I want to also ensure we are working with your child’s best interest in mind” can show that this is not a “me vs you” discussion but rather a “we” discussion focused on the child’s health. It may not end with the family member choosing what we think is best but, if we have provided the information and the space for appropriate decision-making, ultimately that may be the more attainable final goal.
To be a physician, we spent countless hours studying, learning and honing our craft. We choose to sacrifice portions of our youth (or middle adulthood) all in the name of the pursuit of our ultimate career as healers. So, when we make recommendations and treatment plans with the best of intentions and all of our knowledge behind us, and patients disagree with them or choose to follow an alternative path, this can be a source of frustration. Rather than feeling defeated or angry, if we lean in to where our patients are coming from, take time to understand how they are coming to their decision, and be deliberate in forming a trusting partnership, it may help make it more clear how we can perhaps allay fears or clear misconceptions and ultimately find a care plan that is both safe, effective and trustworthy.
Amit Singh, M.D., on behalf of the Cook Children’s Experience Team
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