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(Pediatrics in Review. 2008;29:e35-e41.)
© 2008 American Academy of Pediatrics

The Difficult Pediatric Encounter

Insights and Strategies for the Pediatric Practitioner


Andrea Gottsegen Asnes, MD, MSW*
Ambika Shenoy, MD*
 * The Department of Pediatrics, Yale University School of Medicine, New Haven, Conn

The first 300 words of the full text of this article appear below.


   Introduction
 
All pediatric practitioners are familiar with the concept of the "difficult" encounter with a family. Such encounters can range from those that leave clinicians with a slightly uneasy feeling once the family has left the office to those in which actual disputes occur. Barbara Korsch, MD, wrote, "There are certain names on the day's schedule that make the practitioner's heart sink and feel fatigued in advance." (1)

Although the responsibility of an effective partnership between pediatric practitioner and parent is shared, the larger part of the task falls to the clinician. A recent policy statement published by the American Academy of Pediatrics (AAP) refers to pediatric clinicians as "privileged and trusted advocates for the well-being of children." (2) With privilege and trust comes the responsibility to foster relationships with families and to fortify such relationships when they are threatened. The AAP states that "communication and collaboration" are principles of professionalism in pediatric practice to be upheld. In addition, the statement says that pediatric practitioners must recognize that "patients’ families and the health care team must work cooperatively with each other and communicate effectively to provide the best patient care." (2)

Our own experience leads us to believe that although not all difficult encounters with families can be overcome or smoothed over, many can. Recognizing patterns of interaction that can lead to conflict with parents and addressing them early can be highly effective in preventing escalation. Many conflicts, once understood, even can lead to an enhancement of the partnership between clinician and family.

The following case vignettes illustrate several types of difficult interactions with families that we have had in our pediatric practices. Each is followed by suggestions that the pediatric practitioner may find useful. Although it can feel awkward, even false, to try these . . . [Full Text of this Article]






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