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Before You Get Mad at Your Pediatrician...

Last week, a mom got mad at me because her son had an ear infection. She had come in the Friday before with her 18-month-old, who had a bad cold that she was sure was turning into another ear infection. I had checked his ears carefully and told her they both looked great. And I tried to make it sound like good news: Maybe he's outgrowing the ear infections. Maybe we're in for a better winter this year! But his mother looked at me dubiously, and I could tell what she was thinking: Yeah, and maybe I'll be back in three days with a sicker kid.

And she was. I saw the little boy again on Monday, after he'd had a miserable weekend of sleepless nights and nose-drippy days. This time, he clearly had an ear infection. He also had a fever, diarrhea, and diaper rash. You get the picture. His mother was pretty annoyed with me. If only I'd listened to her on Friday, she felt, we could have gotten started with the antibiotics and he might be getting better. She had a point.

The week before that, some parents got mad at me because I kept their kids waiting over an hour for their physicals. They pointed out that they'd made these appointments months ago, fitting them carefully into a busy family schedule, and had shown up on time. And there I was, taking care of other patients while they waited, with every sick child in the office coughing in their face. They had a point.

Parents get mad at me all the time, sometimes for something I've done, like reassuring them about a rash that wound up getting much worse. Sometimes it's for something I've had to do that turned out badly, such as giving an immunization that caused a fever and a cranky night. And sometimes it's for something completely beyond my control: I ordered a blood test that the lab technician had trouble drawing, or I sent a couple and their new baby to the emergency room, where they waited for hours.

And you know what? I apologize for all those things. I'm sorry I was wrong about the rash. I'm sorry about the bad night following the shot. I'm sorry the ER was so slow. No matter how crabby parents are, it's part of my professional drill to remember that their anger comes from the anxiety of seeing their child suffer and that my response should be reassurance and, yes, apology.

There are times when parents are justified in getting upset with their pediatrician. As a mom, I know what it's like to wait patiently to be seen by a doctor who is rushed and preoccupied: A specialist who saw one of my kids actually checked his e-mail messages repeatedly throughout our interview. And I know what it's like to think my child is sicker than the doctor does, and be right -- though I've probably been wrong more often than I've been right.

But I don't believe you should get too angry at your doctor over, for example, a delayed diagnosis or one that turned out to be inaccurate. On the one hand, I've told parents that I thought their child's development was totally normal, and then had to refer them for full evaluations a few months later. But I've also caused parents tremendous worry by bringing up the possibility of developmental delay when the entire time their boy was just a little slow to walk but otherwise okay. I claim the professional right both to make mistakes and to remind you that pediatrics isn't just a science -- it's an art.

Other issues involve logistics. Take on-call phone calls. I try to return evening and weekend messages pretty promptly, but every now and then I have a valid excuse for not doing so: I got three calls at once, for instance, and the first one I returned was complicated, the kid was really sick, and I ended up calling an ambulance. However, if it always takes hours for a pediatrician's office to call you back, then something is wrong with the doctor's system. A concerned parent is entitled to know that someone will call back and take the problem seriously.

As for keeping families waiting in the office, I wish I could say that I'm usually prompt, but I know that I'm often running late. Depending on the day, I might offer one of a number of slightly self-serving explanations, such as the parent with one appointment who brought along two extra kids. Or the 15 minutes I spent on hold with a specialist, trying to get a test result for a worried mother.

But if long waits are the rule, you have the right to get mad. And the more you get mad -- in a reasonably civil way -- the more likely I am to try to find a solution.

In the end, the key to smoother parent-pediatrician relations is openness and honesty. If you feel your anxieties have been dismissed or that you've been treated rudely, let the doctor know. All I'd ask is that you consider this: The other parents we deal with feel just as strongly as you do about getting their children properly taken care of. You shouldn't judge us too harshly for any single offense. But don't swallow your anger or let it build. And don't leave the practice without telling us why.

Parents often say that pediatricians are like members of the family who watch the children grow up and change. Well, with the honor of being part of the family comes certain risks. You know how it is in a family: Sometimes people get mad.

Contributing editor Perri Klass, M.D., is the mother of three and the author of Love and Modern Medicine, a collection of short stories.

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