Dear Doctor

A few suggestions for pediatricians, from the mother of an inexplicably ill child.

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Don't scold the parent for not telling you something they wrote on the intake form you have in your hand and that you hadn't yet asked about.

Don't say, "What do you mean, her stomach hurts? How can you tell?" in a tone that implies that since the child can't talk much, the parent can't possibly know she's in pain.

Do use the child's name when talking about her, especially when changing subjects from family history, etc. back to the child.

Do check to make sure you are in the examining room for the correct patient.

Do take a glance at the child's chart to make sure you know their name, approximate age, and reason for the visit before walking into the examining room.

Do take into account that the parent may be exhausted, worried and worn out. Don't be too hard on her if she dissolves into tears in your office.

Do remember that other doctors may have told the parent some of the things you're getting annoyed at her asking about.

For instance, if the referring doctor suggested to the parent that the child's problems are the result of allergies, then don't give the parent a lecture about not assuming every problem is allergy-related. If the referring doctor suggested that celiac disease should be ruled out, don't tell the parent that the child doesn't look like she has celiac and that just because her sister, niece and several other relatives may have it doesn't mean the child has it. The parent probably already knows that.

Do realize that the parent is not expecting you to immediately fix or explain every detail of the child's problems. But the parent is probably expecting you to take them seriously and try to work toward finding a solution. If you can't find a solution, the parent is hoping you can at least help her figure out how to cope with the child's issues (or refer her to someone who can).

Don't cancel an appointment less than 30 minutes before it's scheduled, for a reason you should have figured out a year ago (or at least the day before, if not months ago when the patient made the appointment).

Please do not try to tell a parent that it's not possible for an allergy to anything other than peanuts to be as severe as her child's allergies are.

Also don't say things like "nobody's allergic to rice" and single that out as the one thing not to test for when you are testing for allergies to all grains. Especially when the child is allergic to two other closely-related grains and has suddenly started gagging and spitting out rice whenever it touches her mouth, and the parent is asking for it to be included in the testing you are about to do.

Don't claim that "It's impossible for anybody to ever have an allergic reaction to this. There's nothing in this product that anyone could be allergic to, ever. That's ridiculous."

Especially when both the medical literature and the package insert say that allergic reactions to that product (including anaphylaxis) have been observed and that it can be contraindicated for people with your patient's specific allergy.

Don't say "I'm not going to argue with your anecdotes" when the parent tries to explain that their child HAS had allergic reactions to even trace amounts of the problematic ingredient in the above item.

Above all, don't refuse to even discuss possible alternatives or precautions for dealing with the allergy with the parent, simply saying, "I'm not going to argue with you about it. We're going to give this to your child and that's the way it is."

If you do have to give the child something they have a known allergy to, you should at least be willing to discuss taking precautions (such as having epinephrine available) with the parent.

Don't blame everything that's ever wrong with the child on allergies if there's no obvious other cause. Just because the child has allergies doesn't necessarily mean other causes for symptoms should not be considered.

On the other hand, don't rule out the possibility that a child could have symptoms other than the classic, typical allergic reaction in response to an allergen.

Do admit it if you don't know what's wrong with the child. But please don't give the impression that just because you can't find a cause for the symptoms they are not worthy of concern.

Don't try to tell a parent that colic lasts for 15 months or that "some kids just cry a lot."

Don't tell a parent that since their child looks fine, there must be nothing wrong with her. Especially when that child is sitting unresponsively on your office floor, staring into space, after screaming and refusing to eat for several days--and this has been going on for weeks or months.

Do feel free to say things like, "I'm sorry. This must be hard for you and your child. You're doing a good job as a parent. Your child's pain is not your fault."

Don't just guess at the answer to a question if you don't know. For example, if the patient's parent asks how long the child needs to be eating gluten for a celiac test to be accurate, don't say something like, "Oh, I would think a day would be enough" when you don't know.

And if the parent asks for more information, it might be helpful for you to actually find out or make a referral instead of just giving them the phone number of a nearby specialist's clinic with instructions to call and ask the doctor there without making an appointment.

Above all, do listen and pay attention during the appointment--to both the parent and the child. Do read the information the patient's parent wrote down for you. Do assume that the parent has some level of intelligence and knows what is or is not normal for the child. And do treat the patient and the parents with respect. Please.