Pediatric eye care requires the ophthalmic technician and supporting staff to have a broad knowledge of developmental visual system diseases and available medical, optical, and surgical treatments. While these requirements are critical, the staff should not overlook the need to establish separate patient and parent (caregiver) relationships. Here, I provide tips for establishing these relationships, which is a cornerstone of pediatric care.

Set reasonable expectations for yourself.

Most staff who work in pediatric ophthalmology have chosen that subspeciality due to the joy of working with infants and children, and diagnosing and treating their unique visual system diseases. But, staff also must adjust their expectations to accommodate a relationship with the parent.

For example, most of the staff’s face-to-face time is consumed by interacting with parents and other family members, not the child patient. By reconciling and coping with this necessity, the practice can provide a gratifying experience for all staff and a satisfying experience for the family.

Also, many parent visits to the ophthalmic subspecialist are associated with a variety of emotions. First is the fear that their child will go blind or be permanently visually impaired. They are usually anxious about the child’s future academic, social, athletic, and driving capabilities, the character/expertise of their physician, and the process of diagnosis. In addition, it is common to find that parents have a sense of guilt that in some way (pregnancy, labor, delivery, or ignorance) they are responsible for their child’s problem. Understanding this “parental baggage” creates a positive foundation for the parent-staff relationship and helps us to recognize, evaluate, and be realistic regarding our expectations of the parent relationship.

Use simple, clear, and direct language.

Our goal for the family during the office visit is for them to leave feeling attended to, trusted, cared-for, and respected in a non-judgmental way. This is fundamentally accomplished using direct, simple, clear, and socially appropriate verbiage. Studies show that patients and family often forget or misremember what is said to them once they exit the examination room.^1,2 This is usually due to use of medical terminology, the mode of information transmission (eg, spoken versus other media) and language, social or educational, and family barriers.³

Thus, parents leave with lasting feelings more than lasting information. In a study of patient-centered care in ophthalmology, the authors found that in addition to a reputable physician with experience, the patient’s expectations include honesty, information about their diagnosis and prognosis, clear language, listening skills, and empathy.⁴

How to improve your bond with parents.

The time consumed by non-clinical demands (regulatory, financial, continuing education, legal protection, and record keeping) continually competes with our ability to develop meaningful staff-patient and staff-parent bonding. Despite these demands, I have found the following tips, accumulated from my 30+ years in patient care, useful in improving the practice’s bond with parents:

• Introduce yourself to both parents and patient.
• Quickly assess the child’s mood, level of fear, and ability to cooperate.
• Take advantage of interacting with the child as soon as possible and as much as possible (eg, with parent consent, defer extensive discussion with them if the child can be approached for technical evaluations).
• In the 13-36 month age group many children are fearful and reluctant to be examined. In those situations, allow the child to sit on the parent’s lap in a non-exam chair while history is obtained from the parents, slowly gaining the trust of the child.
• Relay to parents that staff will be happy to discuss findings, diagnosis, prognosis, and recommendation when the evaluation of the child is completed and at a time when the patient’s attention is not needed. If parents ask questions while typing or writing I usually reply, “I am happy to answer your questions but just give me a minute to finish so I don’t make a mistake.”
• During discussions, stop everything else, focus, and make eye contact.
• Prior to saying goodbye, end the visit by asking the patient and parent if there is anything they would like to say or ask.

Be courteous regarding differences in opinion.

It is important for staff to try not to react personally to the parent’s affect, questions, concerns, or previous behavior. Most of the time, the parents are behaving in the best interest of their child. It is best to communicate to the family in a direct fashion and to understand that what the family chooses to do with our evaluation and subsequent opinion is out of our control.

It is crucial that we do not expect that the parents will always act in concert with our opinion. Our evaluation and subsequent opinion may be one of many (eg, other eyecare practitioners, family, friends, colleagues at work, the internet, and other media). It helps to not dismiss the family’s preparation for the visit. If they bring old records, internet searches, or video recordings, for example, staff should thank them for their work, ask to copy it, and state that they will be happy to share all materials with the provider. I recommend staff stay away from comparing our methods to others or discussing why others differ from ours.

Whether or not our relationship with the family continues should be left to the parents, not us, so it is best not to pressure any decision making. In the rare situation where a relationship with the parents needs to be discontinued, administrative staff, in concert with the provider, should simply communicate to the family why the practice personnel are uncomfortable and then suggest alternative care situations.

Summary

Parents want their health-care personnel to be accessible, honest, and to communicate with a caring affect, using lay language at a level with their ability to understand. Not attending to or dismissing parent’s concerns often results in feelings of anger, betrayal, distrust, and ultimately promotes poor adherence to care of the child patient.

In many ways, staff are in the crucial position of impacting the parent experience due to their continued presence throughout the visit. By following the tips above, staff will increase the likelihood of making that experience a positive one. OP

REFERENCES:

1. Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219-222.
2. McGuire LC. Remembering what the doctor said: organization and adults' memory for medical information. Exp Aging Res. 1996;22(4):403-428.
3. Ley P. Memory for medical information. Br J Soc Clin Psychol. 1979;18(2):245-255.
4. Tipotsch-Maca SM, Varsits RM, Ginzel C, Vecsei-Marlovits PV. Effect of a multimedia-assisted informed consent procedure on the information gain, satisfaction, and anxiety of cataract surgery patients. J Cataract Refract Surg. 2016;42(1):110-116.

Dr. Hertle is the chief of pediatric ophthalmology and director of The Children's Vision Center and the Dr. Robert "Boomer" and Jill Burnstine Chair of Ophthalmology at Akron Children’s Hospital in Ohio. Also, he is a professor, Department of Surgery, College of Medicine, at Northeast Ohio Medical College in Rootstown.