After learning something about how they think, you might offer more data or more warm acknowledgment of how difficult it can be to make medical decisions for your children with imperfect information. Be humble while also being accurate about your level of confidence in a recommendation. Humility is important because it is easy for parents to feel insecure and condescended to. You understand their greatest fear, now let them know what your greatest worry is for their child should they forgo a recommended treatment. Explaining all of this with humility and warmth makes it more likely that the parents will take in the facts you are trying to share with them and not be derailed by suspicion, defensiveness, or insecurity.
Make building an alliance with the parents your top priority. This does not mean that you do not offer your best recommendation for their child. Rather, it means that, if they still decline recommended treatment, you treat them with respect and invest your time in explaining what they should be watching or monitoring their child for without recommended treatment. Building trust is a long game. If you patiently stick with parents even when it’s not easy, they may be ready to trust you with a subsequent decision when the stakes are even higher.
Dr. Michael S. Jellinek
Of course, there may come a time when a parent’s refusal to accept recommended treatment constitutes medical neglect. The decision to file with your state’s Department of Children and Families (or equivalent) should be guided by the severity of the potential consequences to the child, and it will help if you are confident that the parents understood your recommendations and associated risks and benefits. Where there is imminent risk, the law gives you no choice about the decision to file. If you have invested in a strong alliance with the parents, it will be easier to explain filing and its consequences to them. It may even be that they will want to continue with your practice in the aftermath, as they trust in your honesty, your dedication to their child’s health and safety, and your capacity to treat them with respect even in disagreement.
Of course, all this thoughtful communication takes a lot of time! You may learn to block off more time for certain families. It also can be helpful to have these conversations as a team. If you and your nurse or social worker can meet with parents together, then some of the listening and learning can be done by the nurse or social worker alone, so that everyone’s time might be managed more efficiently. And managing skeptical parents as a team also can help to prevent frustration or burnout. It will not always succeed, but in some cases, your investment will pay off in a trusting alliance, mutual respect, and healthy patients.
