Unsolicited Advice
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Dr Shapiro completed his undergraduate education at UC San Diego earning a B S in Biochemistry and Cell Biology and a B A in Political Science He furthered his education at UCLA where he earned a Masters Degree in Public…
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I'm looking for some feedback here. Whenever I'm out...with friends, a child's birthday party, etc...without fail, I will get one or two medical questions thrown my way. And while some of you might be surprised, I really do enjoy it. I believe it comes with the territory of being a physician...or shall I say, at least being a pediatrician. Granted, not all of my colleagues would agree with this viewpoint, but frankly, that's their problem, not mine.
But my question to you all is when unsolicited advice comes your way. Now, I'm not specifically talking about giving parenting advice as I firmly believe (and you've heard me mention this before) that there are many effective parenting styles and my goal is to just keep parents on the path they've chosen. But what I am talking about is when I notice something concerning about a child...particularly when it is a child of a friend of mine. And no, I'm not necessarily talking about telling a parent his child has ringworm and should run to the store for an antifungal cream. But more specifically, my predicament arises when I notice a possible developmental issue in a friend's child.
We all know of the importance of early intervention in regard to developmental delays...the earlier services are initiated, the likelihood of a better outcome increases. And this is where I'd like to hear back from parents, grandparents, or anyone with a viewpoint on this. How would you like to be approached on this matter? A style I usually employ is to casually ask the parents (remember, these may be friends I may now only be seeing once every few months) about the child's pediatrician and the office visits...seeing if it sparks a further discussion about a concern the parent may have. If it doesn't trigger a response, I typically push the issue a bit further all the while trying to be respectful of the situation.
Nevertheless, sometimes it can become a bit awkward and part of the reason I'd like to hear back from you all.
Dr. Jeremy
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Displaying comments 69-50 of 69
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I'm not a Dr or anything but I noticed that my husbands cousin (15yrs) had a curve in her spine and knew straight away that it looked like scoliosis. I approched her mum and just asked if they have ever had her back looked at by a doctor, when her mum said no I said that obviously I'm no doctor but I pointed out what I noticed (uneven waist, shoulders etc) we got her daughter to touch her toes and I showed her my concerns as one side of her back was higher than the other, again, I said I could be wrong and it could be nothing (but in my mind in knew) they took her to the doctor and sure enough I was right, they have been so greatful and glad that I was concerned, as they had often roused at their daughter to "straighten up". If they had have said that they were seeing someone about her back when I asked, than I would have just said ok and left it there, than they have the option to tell me more if they wanted to.
I worked in child care for sometime and once had the difficult task of suggesting to a parent that they need to speak to their doctor about their child's development. The child had an obvious developmental delay, the way I brought my concerns to the parents were through simple devlopmental checklists. I showed the parents what was expected of a two year old child (socially, physically, cognitively, etc) and the child basically had the skills of a 12 month old physically and a nine month old socially, but I had no idea as to what could be the cause. At first the mother was not convinced, I was very concerned an did follow up checklists every fortnight and presented them to the mother, one day the father came to pick up his daughter instead and I showed him the checklists, turns out his wife had not mentioned anything to him, after a long chat he decided to get some professional advice, months later the child was diagnosed with Rett Syndrome, a vary rare condition in girls. I'm glad I pushed the topic. I would have felt awful if I never did anything and they found out years down the track, knowing that I could have got them early intervention.
As a parent myself, I would welcome any concerns about my childrens health to be brought to my attention, wether it be by a professional or lay person.
Thanks,
Mark
I would most definitely take advice from a physician.
However, if it were a friend suggesting advice of this sort I would definitely loose the friend. I actually experienced this early on with friends that advised me that there was something wrong with my son. I took action on this, and went to see numerous Dr's. I also eventually decided to sever the friendship too, because there is nothing worse that a friend that tries to pressure you into a which hunt with no real evidence that something is wrong.
Eventually I did find my son was adhd, but could have skipped the extra information from well meaning, albeit ignorant acting people.
Thanks so much for your column,
DM
Most definitely I welcome a friend or even a stranger's observance and advice on a medical condition. It's probably most all in the way the subject is approached--in a caring compassionate manner. I was diagnosed several years ago with three autoimmune diseases (lupus, scleroderma, and rheumatoid arthritis) and was given unsolicited advice by a number of different friends. In addition to different medications I had been on at the time, caring friends suggested several different natural products, which eventually lead me to the perfect ones that worked for me. Today, I am symptom free and feeling so very well, so you'd better believe I will always be open to caring unsolicited advice. I feel you are offering compassionate advice to your friends/acquaintances, so I say, "keep it up." meri_terry@yahoo.com
I have found that being a friend and having related professional expertise can tip the scales in terms of getting parents to seek additional assessment/support for their child. Here are my general rules for providing “unsolicited advice”:
• Ask myself whether there is a physical risk to the child and/or will it make a difference in 6 months.
• Express concerns privately, face to face, and use relevant comments by the parents as a starting point for the discussion.
• Give concrete examples / observations of concerns related to language, motor milestones, play and socialization (to name a few); avoid any labels even when asked by the parent.
• Suggest assessment through BOTH the pediatrician/specialist and the interdisciplinary early childhood intervention program; this free (not income based) program is typically offered through the school district in a child appropriate context (play/home).
• Stress that assessment can provide new insight about their child and interventions can make a meaningful and lasting difference to their child both at home and in school.
Thanks for asking and the opportunity to weigh in on this sensitive matter.
I NEED HELP AND NEED SUPPLEMENTAL MEDICAL TO CONTINUE IN THE STATE OF FLORIDA. IF ANY DOCTORS ARE OUT IN THIS SITE PLEASE ADVISE. I NEED YOUR COMPASSION AND HELP IN THIS AREA.
THANK YOU FOR YOUR TIME
MICKEYITALY3@AOL.COM
OR LEAVE ME YOUR PHONE NUMBER
I am not a medical professional.
I am open about my specific experience(s) with a similar life situations. I avoid specific advice like the plague.
The value and willingness to act on my professional advice is measured by people who seek me out and pay for something they want and think they need. My experience is that free advice is thrown away.
I would run with it, and I would both urge and recommend that you exercise your beliefs according to your position. I hope this is of some assistance, and even if it is not, then rest assured at least, that out of respect of you as a professional I personally would take on board any advice you had for me, be it as a friend or not, so keep up the good work regardless.
My husband is a social worker (for children) who also has made countless home visits, etc. in his work environment, and a work environment is very different than being at a friend's house for a Sunday barbecue. I have witnessed him in our private lives trying to help parents and their children that he sees are in trouble (and usually don't know it), but no matter how subtle he is, there is just no penetrating that "wall of denial."
He now sits silently by, observing sometimes damaging behavior. I see it too. It's as if the parents are blind to the expression on their child's face. But we never judge. We know it's easy to watch from the outside, but not easy at all for those in the middle of it. Our friends are struggling to do their best. (Although some parents should never have been allowed to be parents. I cringe when I see some mother in the grocery store screaming horrible things at a small tot.)
We watch as our friends' kids get older. There is often a missed "window of opportunity" with emotional health as well. We've seen the problem get worse, but we've also seen circumstances where the child seems to evolve in a healthy way despite their crazy parents! We do our best to be there in a non-intrusive way for the child and be "the grownups who know your parents but you can say anything to US." We like to think it helps, especially if the parents are going through a divorce.
The problem is that parents are very territorial about their kids. That's just natural. But you are a medical doctor seeing possible medical problems and that, in my opinion, is much more critical. From the way you write, I just assume that you are ALREADY being as tactful and respectful as possible. What works for one parent will not necessarily work for another. I think you just have to follow your instincts, and hone your "intervention skills" as you go along, doing what feels right for that particular situation.
But keep on speaking up. Even if you get rebuffed, you will have planted a "seed of concern" in the parent's head that will probably stick there, and grow, if the child really has a problem. You just may never know whether or not the parent is doing anything about it because the parent may not want to say, "You were right! If it wasn't for you, I would have completely missed it!" Just put your best out there because it really is the right thing to do.
I am surprised that some of your colleagues do not agree with this. That makes me mad. In this world of ten-minute office visits, how pompous of them to hold on to some archaic ideal of professionalism when the medical profession in general has been reduced to an assembly line. You can tell your colleagues I said that.
Parents generally are not aware about the "windows of opportunity" when we're talking about child development.
If you have a state program called "Healthy Start" they should be able to help you find out how to obtain the original copies. If not, your state Health Dept could direct you to the right Dept. I hope this helps.