By Carrie Cuffman, MD
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It’s 4:47 p.m. on a Friday, and a frantic parent calls the office needing her son’s medication refilled before they leave for vacation on Sunday. A routine prescription refill has become an emergency for a child.
On Monday, I change the dosage on a patient’s medication. Her mother calls later that day to make sure the dose is correct. She calls again on Tuesday, then twice on Wednesday with more questions about the medication.
Later that week, I ask the parent how her child is doing on a new medication and learn that she forgot to fill the prescription. Scenarios like these are common in a developmental pediatric practice and are not unfamiliar to general pediatricians and many other pediatric specialists. A parent’s current mental state and/or overall mental health can make the healthcare team’s job of caring for the child more complicated and at times create additional work for the healthcare team. We would like to suggest ways to accommodate these behaviors to help reduce parental stress and improve office staff effectiveness.
Ask about it
While gathering a family and social history, be sure to include questions about parent’s mental health and stress levels. Asking about mental health in this context is a non-threatening way to obtain important information. Using written or online questionnaires to gather the information (for example, the Edinburgh Postnatal Depression Scale at newborn visits or the PHQ-2 as a part of social determinants of health screening) can also be effective. Including a discussion of parental mental health in each visit will make it easier to address the topic when concerns arise.
After gathering information about the parent’s mental health, don’t be afraid to address it directly if you have concerns. Parents want the best for their child, and most understand the importance of modeling behaviors they want their child to display. As a developmental pediatrician, I treat many issues in children—anxiety and ADHD among them—that have a strong genetic component. Thus, a parent may have similar mental health and personality traits as their child. Using the child’s wellbeing as a springboard can bring any parental mental health issues to the fore and make it easier to begin a discussion with the parent about their own mental health.
For example, when a parent’s anxiety is causing unnecessary turmoil in our office, I address it. Talking about changing their child’s behavior provides a nice segue into encouraging them to examine their own behavior. This may not be so easy for a general pediatrician, but I have found these parents are often receptive to being referred to a mental health provider.
Use EMR alerts
Your electronic medical records system can be a tremendous asset. Set alerts for you or your staff to call parents before their child’s prescription runs out or remind them to make or keep the next appointment.
These proactive measures takes some of the burden off parents. Importantly, reaching out to parents can alert you to families with transportation or financial issues that are preventing them from filling a prescription or making the next visit. Knowing this will enable you to find them the necessary help to prevent their child from being lost to follow-up.
Take a personal approach
Anxious and stressed parents may benefit from reassurance in the form of one-on-one communication. Consider having a member of your office staff call them at set intervals to ask how their child is doing. It will require you to set aside time, but it can be done at your convenience. Ultimately, it may take less time than answering or returning multiple unplanned phone calls.
Use the resources you have
Barriers to care are an ongoing problem in pediatrics and include lack of transportation, lack of fluency in English, confusion over insurance, unstable job or housing situations, limited financial resources, and more. Mental health concerns simply compound the problem.
Social workers and clinical coordinators can provide a lifeline for these families. They are valuable resources, so don’t hesitate to call on them for help.
Utilize virtual visits
Many families find it easier to keep virtual appointments, and young patients may be less stressed when the doctor visits them at home.
How long insurance will continue to reimburse for virtual visits is unknown, but we advocate continuing to see patients electronically as long as such visits are appropriate.
Parents do not want to be viewed as adversarial. As pediatricians, we simply want to be trusted and feel that parents are on the same team. Our young patients do best when their parents are at their best and everyone feels valued. Making accommodations for parents who need them will allow us to focus on providing the best possible care for our young patients.
About the author: Carrie Cuffman, MD, is a developmental pediatrician in the Department of Behavioral Pediatrics, Cleveland Clinic Children’s Hospital for Rehabilitation.