After doing this for 23 years, I actually enjoy the challenge of dealing with the overly anxious or hostile parent…but yesterday, I think I met my match! My patient was a little girl with a chronic medical condition that needed an MRI and then an invasive procedure in IR. During her current hospitalization she had a procedure that resulted in a severe bradycardia, necessitating a brief period of chest compressions. The anesthesiologists attributed it to a “vagal reaction caused by distention of a hollow viscus”. The parents insisted on a cardiac consultation, which revealed nothing and recommended anticholinergic tx next time. When the parents arrived to the MRI suite the dad insisted on interviewing me first, or he would cancel the case. In my usual caring and ingratiating manner, I talked with him for a while and gained his trust…and he seemed fine. In the induction room he told me to give the atropine (I gave glyco) and wanted to know the dose of propofol I was using so he could make sure it wasn’t too much. I responded by asking him what he does for a living, and when he told me that he’s a car dealer, I told him that I wouldn’t come to his business and tell him how to deal cars. He actually appreciated that and backed off. After an easy MRI/IR anesthetic, my patient woke up a little weak, nothing terrible, and was transported to the PACU on room air with SpO2 100%. But dad let me know in no uncertain terms he wasn’t happy with her breathing. We reassured him that she would get stronger within the hour. He insisted to me that we gave too much anesthetic, going against what he said. After giving the usual explanations, I left for him to be alone with the PACU nurse. I came back to check on them about 20 min later where I learned that he told the nurses that “the anesthesiologist didn’t know what he was doing.” For probably the first time in my career I almost lost it (but I didn’t) and I addressed him fairly sternly about letting us do what’s best for his child without him antagonizing the staff. Since then, I’ve debated with myself whether to have increased empathy for a stressed dad with a chronically ill child, (and as I later found out, a newborn at home and a recent job loss) vs. the inappropriateness of his anxiety and disrespect for his daughters caretakers. Am I out of line? Thoughts?
Posted on October 5, 2013, in Uncategorized. Bookmark the permalink. 4 Comments.
Ron, I’ve had a few of these too. I saw a remarkable tranformation in one parent’s demeanor when a senior anesthesiologist responded to yet another question by saying– VERY calmly and politely–“it’s clear to me that you do not trust me to care for your child. So let’s take a step back, postpone today’s surgery, and I’ll help you find someone that you think you can trust. Because I cannot compress what I’ve learned in “x” years of school and “x” years of practice into a 10 minute answer. And I can’t proceed if you are starting from a point where you think I would hurt your daughter.” The guy gulped, apologized, and asked my colleague to proceed. The fact that he brought the surgeon into the discussion was also helpful.
“In the induction room he told me to give the atropine (I gave glyco) and wanted to know the dose of propofol I was using so he could make sure it wasn’t too much. I responded by asking him what he does for a living, and when he told me that he’s a car dealer, I told him that I wouldn’t come to his business and tell him how to deal cars. He actually appreciated that and backed off.”
In hindsight it’s always easy to say what could have or should have been done or said.
Although parents have the right to know details and to ask questions, the timing of the atropine and the dose of propofol were questions that he should have asked prior to the induction. Perhaps we should make it clear to parents that the induction process requires so much focus and concentration on our part that we cannot answer detailed questions on the fly without compromising our vigilance.
Although I agree with the answer that you gave him, he may have perceived it as confrontational when you consider his high anxiety level. Surgeons sometimes behave the same way when they make simplistic suggestions for us. It is a difficult juggling act to allow them to feel that they have control of the situation without compromising our standards of care.
I’m at a loss to understand why you didn’t tell him you were using glyco instead of atropine and why you were using it. I do like Nancy’s answer.
Thanks for the comment. It’s been a while since this case, but I’m sure I would have explained that to him. He was savvy enough to understand the differences between the drugs.