By Bob Truog, MD, Senior Associate in Critical Care Medicine, Boston Children’s Hospital
Perhaps the most gratifying question I am ever asked as a pediatrician is, “Doctor, if this were your child, what would you do?” So often today, being a physician can feel like being a technician—parents come in believing they already know their child’s diagnosis from their Internet search. They know what tests they want me to order and what prescriptions they want me to write.
But when they ask me this question, it’s as if our relationship is transformed. They are telling me that they trust and value my opinion; they want my best judgment as a doctor and as a person. Indeed, throughout my training as a pediatrician, my teachers always told me to treat my patients as if they were my own children, and this is a standard I have always tried to live up to.
I think that parents often take comfort in asking the question as well. They are inviting the physician to think of the relationship as a partnership, more than just a process. Particularly in the intensive care unit, where I work, parents must often make extraordinarily difficult decisions for their critically ill children. In these cases, I think it may be helpful for them to think that we are making the decisions together—I am there to take some of the burden off their shoulders.
One thing I’ve noticed over the years is how some parents will bring in pictures of their children, when they were well, and post them all over the child’s hospital room. I used to think that they were doing this just for themselves, like we have pictures of our family on the refrigerator or our desk at work. But I’ve come to see that sometimes parents are actually doing this for us, to pull the doctors and nurses into a more intimate emotional engagement, to literally think about this child as if he or she were our own child.
For all these reasons, this question can serve as a wonderful window for doctors, nurses and parents to enter into a level of trust and intimacy that everyone can find gratifying and beneficial. But I think it is also important for all of us to recognize that there is a potentially serious problem with this question, one that we all need to recognize and protect against.
Most medical decisions—and virtually all decisions that involve serious consequences for a sick child—cannot be answered on the basis of medical expertise alone. The decisions also depend upon the values, beliefs and preferences of the child and parents. Many medical decisions, for example, involve making trade offs between the hoped-for benefits of a treatment and the risks, harms or pain that may come along with it.
Doctors and nurses need to remember this, because when they are asked, “If this were your child, would you decide to have this surgical procedure or begin this new medication?” they need to remember that their personal values and beliefs may not be the same as those of the child’s actual parents. Parents need to remember this too, because when they ask this question, they also need to remember that the doctor’s or nurse’s values and beliefs may not completely match their own.
When I teach our young physicians at Boston Children’s, I always tell them that they must approach this question very carefully. Instead of answering it simply and literally, they should use the question as an invitation to explore the values and beliefs of the parents. Ask them about what matters most to them, what they most hope for, what they most fear, what potential outcomes would be intolerable for them, how their child copes with pain, adversity or disappointment.
When doctors and nurses approach the question in this way, we can be much more confident that the decision the parents make will be the right one for their child and themselves. When everyone remembers this simple, but often overlooked, need to explore and respect differing values and beliefs, then this question can indeed lead to some of the most gratifying conversations that parents and pediatricians can have.