Dealing With Difficult Parents

For the past several years, I’ve listed “difficult parents” on my department’s conference evaluation form as my answer to the question, “What do you consider to be the single biggest problem that you face in your practice?” At times, I have to admit that difficult parents have made me dread my decision to become a pediatrician. I recently had a frustrating encounter with a father of a vaccine-delayed child who I had not seen before. The father incorrectly believed that his son needed only one injection; in actuality, he needed 4. Despite 20 minutes of counseling, which included a review of the child’s vaccine history and the recommended vaccine schedule, the parent just didn’t trust my instruction that 4 vaccines were needed, so the vaccines were not administered. Eventually, the patient did return to my colleague and receive the 4 vaccines at a visit that required fewer than 5 minutes of my colleague’s time. My time and frustration basically went uncompensated.

This story is a just minor example of a difficult parent encounter. Most pediatricians could rattle off similar encounters and others of a more serious nature. Difficult parents can come in a variety of forms and be described in several ways . . . abusive, addicted, angry, distrustful, noncompliant, zoned-out, and so on. I’m sure I could think of a difficult parent type for every letter of the alphabet. Dealing with each difficult parent requires its own specific tact to allow for a smooth clinic visit. Some clinic visits may not be smooth no matter what tact is displayed, and it may take a few visits to turn a situation around—as exemplified in my vaccine-delayed patient.

I have found that listening is one of the most important skills to master when dealing with difficult parents. I admit that remaining quiet long enough for parents to fully express their concerns, without interrupting, can be next to impossible when you just want to jump in and give your opinion so you can get to the other 20 patients in the waiting room. Practicing restraint for longer and longer periods can make us much more skilled in the art of listening.

As an attending pediatrician at a medical school, I try to model the process of restraint. I whittle away all excess information parents provide and determine the exact reason why they brought the particular issue to the pediatrician. When the reason is understood and reflected back to the parents, often the difficulty goes away. Obviously, it doesn’t always go away, no matter how much time or understanding you provide. By sharing difficult parent encounters (with the patient’s privacy protected, of course), we can pick up pointers from each other on how to improve our dealings with difficult parents. How do you deal with a parent who is obviously under the influence . . . or who is drug seeking? How do you deal with a parent who is angry, probably about an issue that has nothing to do with the present office visit? How do you deal with the noncompliant parent who has one excuse after another for the lack of compliance?