It’s ironic that I left clinical practice for one of the very same reasons I entered into it in the first place: families. Don’t get me wrong – I still love working with families. They are a key to successful practice in medicine, and are the cornerstone in clinical family and patient-centered care. If you haven’t checked out the Institute for Patient-and Family-Centered Care, I highly recommend it. (And I have taken all the work out for you by providing this lovely hyperlink.) Families are a huge reason I specialized in pediatrics: I loved the idea of nurturing change and providing education to a group of people that have tremendous influence on a child. Children do not grow up in vacuums. Real change and intervention has to happen with the caregivers. And many of the families I worked with over the years were gracious, kind, and motivated in caring for their children.
I wasn’t naive enough to think I was going to have a mind-blowing experience working with every single family in my clinic. But there were some parents that really caused me to struggle immensely in my practice. Surprisingly, it wasn’t the aggressive over-parenters that really got to me. Sure, I had my issues with helicopter parents who would come in demanding some brand new test they saw on TV be run on their (healthy) child so they could confirm exactly what was wrong THIS INSTANT. Never mind that the test cost $1500, took seven weeks to run, and was intended for identifying illness that only occurs in populations that regularly ingest raw brains as part of their diet. Somehow, I always managed to eventually find a common ground with these parents and figure out a way to meaningfully collaborate in taking care of their kids.
My true achilles heel lay with the parents who were the exact opposites: The Passive Parents. These are the folks who simply weren’t that actively involved with parenting their children. It happened for a variety of reasons. Some just weren’t interested in parenting (despite that they were, in fact, parents.) Some decided to twist the Montessori educational method for their own purposes, and insisted that children learn from the world and each other, so that they were actually doing harm if they ever ran interference where their kids were concerned. (Hey genius, if your kid learns that his old sister can bully the hell out of him and you will stand around and watch and never set any limits for anyone, you’ve done a fabulous job teaching your kid learned helplessness. Way to empower your child.)
But my ultimate nemesis were the parents that were actually afraid of their own children. Like somehow standing up to a pint-sized version of themselves and actually saying “no” once in a while was the most terrifying prospect they would ever face. I’m not even really talking about parents whose children have already turned into teenagers run amuck and have developed Conduct Disorder and like to set fire to things – that is a very serious concern. The parent’s I’m talking about are the ones who can’t face down their elementary schooler.
I wil never forget one family in particular I took care of in my clinic for several years. “Jack” and his mom came into my clinic for the first time for Jack’s six year-old well checkup. I heard about Jack before he ever got back to my exam room. The nurses actually came to warn me that he was terrorizing the front waiting room, and that the toys (that were actually there for all the children who were waiting to be seen) were scattered to the four winds. Jack apparently didn’t do very well during the nursing screening either when he was getting measured and weighed – I heard the screaming all the way down the hall.
Eventually, Jack finally made it back into an exam room. The frazzled nurse, who was actually quite experienced with “demanding” children, handed me the chart and wished me luck, saying that the mom was going to be no help. I took a deep breath, turned the handle, and entered the room.
It was the “feeding after midnight” scene straight out of Gremlins. Jack had dragged a chair across the floor, used it to climb on top of the sink, and had proceeded to pull all of the plastic basins, boxes, and gowns out and throw them all over the floor. His mother was sitting like a stunned sheep in the corner of the room, too petrified to say anything to her son.
I immediately addressed her, and let her know it was dangerous for her young son to be standing on top of the sink, and she should probably retrieve him. She stood up, walked across the room and picked up her son, and timidly said something to the effect of, “now Sweety, you really shouldn’t be climbing on top of things.” Whereas Jack promptly turned in her loving arms, looked at her, and smacked her dead in the face.
I realized that I was going to get absolutely no help from this woman during the visit. So I asked her to please put Jack down. She did and scurried back to her chair in the corner. I squatted down so I was eye level with Jack, and we just looked at each other for a long moment. I then addressed him in a gravely serious voice, but making sure that I snuck in several glances at his mother to let her know I was addressing her too.
“Jack, I don’t know how you do things at home, and maybe no one explained the rules about the clinic here to you, so I’m going to do it now to make sure you understand. In my clinic, we never, ever, hit another person. Got it?”
Jack stared at me with a curious look, like this was the first time in his life he had ever heard something resembling a limit, and was trying to digest it. We sat there like that for a few seconds while he processed. Finally he nodded and said, “I got it.” The rest of the exam was a piece of cake. If Jack started getting rowdy while I was getting information from his mom, I would simply remind him about the clinic rules, and he would stop. His mom kept apologizing profusely for his behavior, looking all the while like she had seen a ghost (perhaps the Ghost of Christmas Parenting?) At the end of the visit, she appeared so mortified that she could barely make eye contact as she hustled him out of the clinic to the car.
The best part was that apparently, all Jack’s mom needed was a bit of modeling to realize that she needed to get more actively involved in parenting her son, or he was going to end up jumping off a bridge when she wasn’t looking. Six months later, Jack came in for a followup visit. I saw his name on the schedule and admittedly cringed a little. But something had happened in the interim. When Jack came in to the office with his mom, I happened to be standing close to the front desk and he spotted me. Wasting no time, he marched right up to me and said, “Dr. St. Claire, today I’m going to be really good.” I high-fived him and he proudly went with him mom to the check-in desk. His mother was beaming as if she had just won the Boston Marathon. There were no reports of waiting room warfare that day.
Sadly, success stories like Jack were few and far between. Most of the passive parents I saw in my clinic never really gained a sense of active parenting, and it certainly wasn’t a problem a physician was equipped to solve in a fifteen minute visit. I suspect on some level that these kids might not have gotten as optimal medical care as they might have, had I felt I could actually collaborate with their parents and give them a care plan that they felt comfortable taking home. I also worry about these kids growing up. In the 1980s, Psychologist Diana Baumrind identified distinct parenting styles, with the “permissive” parenting style being most often associated with children eventually developing Conduct Disorder.
I have no delusions that I may get some blowback from some offended parents reading this blog who see themselves in my words, and that is perfectly ok. I am not really interested in lecturing anybody on how to raise their kids. Plus I don’t have to: the research and the outcomes speak for themselves regarding how our kids grow up these days. The bottom line for me is that as a physician, I worked very hard for many years to partner with parents in order to provide the best possible care I could for their children. The parents who couldn’t, or wouldn’t, meet me halfway were the ones that unfortunately made my job impossible to do well. I wish them all the luck in the world.