She doesn't have a door

I had recently finished residency, and I was excited. After years of training, I would finally get to be a general pediatrician in a small community. I was ready to be a children’s doctor; one who followed them through years of growth.

I had studied and learned tremendous amounts of information. I knew how to pick up abnormal exam findings, notice red flags, and identify and treat illnesses. I had read parenting books and knew tips and tricks that would help parents through difficult phases and situations.

I knew the information that I had was good, I knew how to communicate it, and I was ready to help people. It was in these early and idealistic days that I had one of my most defining moments as a pediatrician. During a routine well child check, the parents of a young girl complained that she was having a hard time falling asleep. They were frustrated with all the work they were doing to keep her in bed. They were stressed out and needed help, so I gamely reached into my bag of tricks and started making suggestions.

Much to my chagrin, they had a ready answer for each statement:

“One thing that might help is...” “We tried that”

“Have you considered...?” “It doesn’t work”

“You might be able to...” “She just screams.”

It was an aggravating exchange, and after several minutes of being shot down at every turn, I was nearly out of ideas. Desperately, I came out with my last suggestion, “You might just need to close the door and walk away.” The response came swiftly: “She doesn’t have a door on her bedroom.”

I was out of ammunition. Defeated, I muttered something along the lines of “Well, I guess you have a problem, then,” and we moved on with the visit.

To my surprise, the parents did not seem upset with my failure to solve their child’s sleep issues, and they were not put out by my comment. The visit ended pleasantly, and the child continued to be my patient. I, however, was unable to put the encounter out of my mind.

I was frustrated that I had not been able to solve their problem and even more frustrated that they had been so unwilling to positively respond with any advice I had to offer. What had I done wrong?

After mulling over the experience, I finally came to realize that I had misunderstood the parents’ intentions. Although they had expressed concerns about sleep, they were not actually looking for a solution.

Perhaps all they were really looking for was an acknowledgement of the intensity of what they were living with every night.

Initially this revelation came as a shock. I had thought that my job as a doctor would be to find solutions and fix problems. Through this interaction, however, I came to understand that, while my responsibility as a pediatrician is to present potential solutions to a whole host of parenting dilemmas, my job ends at that point. I am not responsible for implementing that advice, and parents get to choose if they even want what I have to offer.

This may seem like an odd realization to call a “defining moment,” but I believe that it has shaped my practice in a profound way. Recognizing where my responsibility ends, I offer my advice to parents more graciously. If they choose not to take it, I can smile and see them back at the next visit, ready to interact with any concerns they bring up then.

Over the years, I have found that the beauty of being a general pediatrician is that I do get to follow kids and families through years of growth and development, and families grow and develop, just like their children. So although she might not have a bedroom door at this visit, there’s a chance that, sometime in the future, she will.

As her pediatrician, I’ll get to be at that visit, and we just might be able to get everybody to sleep then.

Judy Black, MD has been practicing pediatrics for 16 years and currently is a partner in a multi-specialty clinic in Grants Pass, Ore. 

Paperwork aside, Black says she reaps great satisfaction from her work. Fascinated by the functions of the human body and, in particular, the growth and development of children, she loves watching her patients grow over time and helping them develop into healthy adults. 

During her free time, she enjoys knitting, spending time with her husband and children, and traveling. In fact, her retirement plans include touring the country with her husband in an RV. It’s safe to say that she probably will get a lot of knitting done as well.

Her advice for young doctors? “Expect to see a lot of changes in the business of medicine over the course of your career and try to be flexible.”