CONTRIBUTOR / Kelly Michelson
ASSOCIATE PROFESSOR OF PEDIATRICS, DIRECTOR OF THE CENTER FOR BIOETHICS AND MEDICAL HUMANITIES
FEINBERG SCHOOL OF MEDICINE / Pediatrics
Part 1 / Building Trust by Learning to Listen (0:00)
Pediatric-care units are often crowded, and physician-patient relationships are complicated. There are several components to building trust in any healthcare context, but learning to listen to the patient’s family members, who are usually responsible for making decisions, is paramount in pediatric care. Listening, even through the silences, shows you care and humanizes the patient.
Part 2 / Making the Best Decisions: Trust and Perspective (2:36)
In pediatric-care settings, the relationship among physician, parent, and patient is complex and making decisions can present challenges. Listening can help resolve feelings of distrust when one party acts in ways that seem to not make sense, giving insight on their perspective and behavior.
The pediatric intensive care unit can be a very complicated place with a lot of players — there’s doctors, nurses, social workers, chaplains; there’s a lot of people just in the PICU itself.
And then for a particular patient, there may be even more physicians — subspecialists, other providers, just a lot of people running around all the time and people changing over.
I think each component of this VALUE mnemonic is important: we want to value what the family is saying; we want to acknowledge whatever emotions the family is going through; we want to listen; we want to understand where the family is coming from; and we want to elicit questions from the family so that we know that they understand as well.
If I had to focus in on one or two things, I would highlight two. And the first is the L for listen.
When we’re having these conversations, one of the ways that we can help support families is to stop talking and hear what they have to say, even if it means silence, because sometimes it’s in the periods of silence that families realize what they can or feel like they need to say.
And then, the other piece of it that I think is really important and sometimes doesn’t get as much attention is the piece about getting to know the patient or the family or what their issues are — asking them sometimes personal questions about why they feel a certain way, why they’re making a particular choice, and even personal questions about what their situation is like, whether it’s unrelated to the actual decision or discussion that’s going on.
I think it’s really helpful to know that the patient likes to swing on the swing.
And that kind of conversation fosters a lot of trust and support from both sides. So, now the mother knows that I care about her child, or the father knows that we care about their child.
And the healthcare provider also has a personal investment in this particular patient because now I can see what this patient looks like swinging on the swing, and I have a whole different perspective after that kind of information.
BUMPER: Learning to Trust Your Patients
In pediatrics, it’s rarely the patient who decides — sometimes, but rarely — it’s often the parent.
In an ideal world, we’re all making decisions that are important for this patient; we’re not even making decisions necessarily about ourselves. So, when you feel like you don’t have trust for a parent who’s making a decision about a patient, it can be very challenging.
And I think that one of the things that can help mitigate some of those challenges and help smooth things over is to really focus on understanding why the parent is doing or saying what they’re doing, where their behavior comes from.
And I can give you an example. There’s a parent in the intensive care unit whose child has a cancer that’s metastasized and who will likely die — their child will likely die.
And this parent has very difficult interactions with the healthcare team and is often questioning things and doing things in a way that you can’t imagine how that’s helping their child.
But I think that if we understand what the perspective of that particular parent is and why he or she feels that way, and if we look back and we realize that maybe it took this particular parent two months to get their child into the hospital and they feel guilty about that and that they impacted the outcome and that a lot of those emotions influence how they behave, I think it can help unpack the situation.
Really trying to understand the perspective of the parent can be useful when there’s a sense of distrust about what the parent is doing and why.