Bryan Sisk, MD

Whenever I meet families who oppose vaccination, my first response is to flood them with more evidence, reciting the pro-vaccine fact sheet that every doctor knows by heart. I can’t help myself. The evidence is so self-explanatory that it should put any question to rest.

But this approach may just exacerbate the problem. In fact, studies suggest that attacking parents’ beliefs can backfire, and that “attempts to increase concerns about communicable diseases or correct false claims about vaccines may be … counterproductive.” We can inform parents that vaccines prevent thousands of deaths and millions of cases of disease while saving billions in health care costs, but this will not change the mind of someone who does not trust the data.

One major problem is that doctors and parents sometimes speak different languages. As trainees, we are raised on nomograms, algorithms, and clinical trials. When a problem presents itself, we instinctively seek out a rational, data-driven response. This is how doctors are built, but studies suggest that vaccine-hesitant parents may be built differently, driven more by fears and negative emotions than by data. Their decisions seem to be based not on a misunderstanding of the facts, but rather a mistrust of the facts.

As pediatric trainees, this is the world we are inheriting. The more successful vaccines become at preventing disease, the harder it will become to convince parents of the serious risks of nonvaccination. It is a perpetual uphill battle.

To make the future better for our patients (and to contribute to our future sanity), we need to work past frustrations and focus on developing pragmatic solutions. There is surely no easy or perfect answer, and different parents may require different approaches, but the status quo is not working. To find the solutions, we need to develop a robust evidence base to guide our good intentions. Perhaps the answer will come from tailoring communication strategies, refocusing public outreach efforts, creating legal mandates, or maybe something completely different.

And if we are successful, maybe we can close the communications gap between vaccine-resisting parents and doctors.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

Whenever I meet families who oppose vaccination, my first response is to flood them with more evidence, reciting the pro-vaccine fact sheet that every doctor knows by heart. I can’t help myself. The evidence is so self-explanatory that it should put any question to rest.

But this approach may just exacerbate the problem. In fact, studies suggest that attacking parents’ beliefs can backfire, and that “attempts to increase concerns about communicable diseases or correct false claims about vaccines may be … counterproductive.” We can inform parents that vaccines prevent thousands of deaths and millions of cases of disease while saving billions in health care costs, but this will not change the mind of someone who does not trust the data.

One major problem is that doctors and parents sometimes speak different languages. As trainees, we are raised on nomograms, algorithms, and clinical trials. When a problem presents itself, we instinctively seek out a rational, data-driven response. This is how doctors are built, but studies suggest that vaccine-hesitant parents may be built differently, driven more by fears and negative emotions than by data. Their decisions seem to be based not on a misunderstanding of the facts, but rather a mistrust of the facts.

As pediatric trainees, this is the world we are inheriting. The more successful vaccines become at preventing disease, the harder it will become to convince parents of the serious risks of nonvaccination. It is a perpetual uphill battle.

To make the future better for our patients (and to contribute to our future sanity), we need to work past frustrations and focus on developing pragmatic solutions. There is surely no easy or perfect answer, and different parents may require different approaches, but the status quo is not working. To find the solutions, we need to develop a robust evidence base to guide our good intentions. Perhaps the answer will come from tailoring communication strategies, refocusing public outreach efforts, creating legal mandates, or maybe something completely different.

And if we are successful, maybe we can close the communications gap between vaccine-resisting parents and doctors.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

Whenever I meet families who oppose vaccination, my first response is to flood them with more evidence, reciting the pro-vaccine fact sheet that every doctor knows by heart. I can’t help myself. The evidence is so self-explanatory that it should put any question to rest.

But this approach may just exacerbate the problem. In fact, studies suggest that attacking parents’ beliefs can backfire, and that “attempts to increase concerns about communicable diseases or correct false claims about vaccines may be … counterproductive.” We can inform parents that vaccines prevent thousands of deaths and millions of cases of disease while saving billions in health care costs, but this will not change the mind of someone who does not trust the data.

One major problem is that doctors and parents sometimes speak different languages. As trainees, we are raised on nomograms, algorithms, and clinical trials. When a problem presents itself, we instinctively seek out a rational, data-driven response. This is how doctors are built, but studies suggest that vaccine-hesitant parents may be built differently, driven more by fears and negative emotions than by data. Their decisions seem to be based not on a misunderstanding of the facts, but rather a mistrust of the facts.

As pediatric trainees, this is the world we are inheriting. The more successful vaccines become at preventing disease, the harder it will become to convince parents of the serious risks of nonvaccination. It is a perpetual uphill battle.

To make the future better for our patients (and to contribute to our future sanity), we need to work past frustrations and focus on developing pragmatic solutions. There is surely no easy or perfect answer, and different parents may require different approaches, but the status quo is not working. To find the solutions, we need to develop a robust evidence base to guide our good intentions. Perhaps the answer will come from tailoring communication strategies, refocusing public outreach efforts, creating legal mandates, or maybe something completely different.

And if we are successful, maybe we can close the communications gap between vaccine-resisting parents and doctors.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

“It’s best to let her cry it out.” Easy advice to give, but not always easy to follow. The simplest recommendations from pediatricians can pose great challenges, at least initially, for parents. As trainees in pediatrics, we learn the script, but we do not always understand the reality of implementing our advice. Before becoming a parent, “crying it out” seemed the obvious and easy choice. Now, as a parent, I have felt the desperate necessity of getting a child to fall asleep. Although I would never condone unsafe sleeping practices, I understand what drives parents to such extremes.

When the dreaded 2-month-visit came around, I also felt the angst of intentionally putting your child through pain. Sweat dripped down my forehead and my vision blurred when I first saw the nurse immunize my son. Before this, I had ordered countless vaccinations for other patients, and I heard their screaming every day in the halls of clinic as background noise. Yet, seeing my own son being held down and jabbed with a needle was hard to bear. His high-pitched scream seemed perfectly calibrated to pound me with guilt. Of course, I knew the science and I had no fear of adverse events, but seeing your own child in pain does strange things to you. It strikes the same evolutionary chord that sends parents running into traffic to save their babies.

As trainees, many of us have put off having children until later in life. There is nothing wrong with this choice; however, it means that many of us lack the firsthand experience of parenting. We may not know that something as simple as getting a toddler to sit at the dinner table to eat anything can be a night-long struggle. To better prepare new parents and to better understand seasoned parents, we ought to solicit their experiences during office visits. By simply listening for 2 minutes, we can give parents a chance to vent (often well needed and deserved), and we can store their experiences in our memory for future use. Just as we stow away the image of the lacy rash of Fifth disease, we also should stockpile parenting tidbits. The only way to empathize with people going through something foreign to us is to acquire surrogate experiences. Parents in our clinics carry expansive libraries of these experiences, and we should not waste this opportunity.

By better understanding the realities of parenting, we can learn to frame our recommendations in terms that resonate with parents. We can preface our advice with challenges the parents can expect. We can remind them that parenting is hard, but their struggles are normal. When we better understand parents, they can better understand us.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

“It’s best to let her cry it out.” Easy advice to give, but not always easy to follow. The simplest recommendations from pediatricians can pose great challenges, at least initially, for parents. As trainees in pediatrics, we learn the script, but we do not always understand the reality of implementing our advice. Before becoming a parent, “crying it out” seemed the obvious and easy choice. Now, as a parent, I have felt the desperate necessity of getting a child to fall asleep. Although I would never condone unsafe sleeping practices, I understand what drives parents to such extremes.

When the dreaded 2-month-visit came around, I also felt the angst of intentionally putting your child through pain. Sweat dripped down my forehead and my vision blurred when I first saw the nurse immunize my son. Before this, I had ordered countless vaccinations for other patients, and I heard their screaming every day in the halls of clinic as background noise. Yet, seeing my own son being held down and jabbed with a needle was hard to bear. His high-pitched scream seemed perfectly calibrated to pound me with guilt. Of course, I knew the science and I had no fear of adverse events, but seeing your own child in pain does strange things to you. It strikes the same evolutionary chord that sends parents running into traffic to save their babies.

As trainees, many of us have put off having children until later in life. There is nothing wrong with this choice; however, it means that many of us lack the firsthand experience of parenting. We may not know that something as simple as getting a toddler to sit at the dinner table to eat anything can be a night-long struggle. To better prepare new parents and to better understand seasoned parents, we ought to solicit their experiences during office visits. By simply listening for 2 minutes, we can give parents a chance to vent (often well needed and deserved), and we can store their experiences in our memory for future use. Just as we stow away the image of the lacy rash of Fifth disease, we also should stockpile parenting tidbits. The only way to empathize with people going through something foreign to us is to acquire surrogate experiences. Parents in our clinics carry expansive libraries of these experiences, and we should not waste this opportunity.

By better understanding the realities of parenting, we can learn to frame our recommendations in terms that resonate with parents. We can preface our advice with challenges the parents can expect. We can remind them that parenting is hard, but their struggles are normal. When we better understand parents, they can better understand us.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

“It’s best to let her cry it out.” Easy advice to give, but not always easy to follow. The simplest recommendations from pediatricians can pose great challenges, at least initially, for parents. As trainees in pediatrics, we learn the script, but we do not always understand the reality of implementing our advice. Before becoming a parent, “crying it out” seemed the obvious and easy choice. Now, as a parent, I have felt the desperate necessity of getting a child to fall asleep. Although I would never condone unsafe sleeping practices, I understand what drives parents to such extremes.

When the dreaded 2-month-visit came around, I also felt the angst of intentionally putting your child through pain. Sweat dripped down my forehead and my vision blurred when I first saw the nurse immunize my son. Before this, I had ordered countless vaccinations for other patients, and I heard their screaming every day in the halls of clinic as background noise. Yet, seeing my own son being held down and jabbed with a needle was hard to bear. His high-pitched scream seemed perfectly calibrated to pound me with guilt. Of course, I knew the science and I had no fear of adverse events, but seeing your own child in pain does strange things to you. It strikes the same evolutionary chord that sends parents running into traffic to save their babies.

As trainees, many of us have put off having children until later in life. There is nothing wrong with this choice; however, it means that many of us lack the firsthand experience of parenting. We may not know that something as simple as getting a toddler to sit at the dinner table to eat anything can be a night-long struggle. To better prepare new parents and to better understand seasoned parents, we ought to solicit their experiences during office visits. By simply listening for 2 minutes, we can give parents a chance to vent (often well needed and deserved), and we can store their experiences in our memory for future use. Just as we stow away the image of the lacy rash of Fifth disease, we also should stockpile parenting tidbits. The only way to empathize with people going through something foreign to us is to acquire surrogate experiences. Parents in our clinics carry expansive libraries of these experiences, and we should not waste this opportunity.

By better understanding the realities of parenting, we can learn to frame our recommendations in terms that resonate with parents. We can preface our advice with challenges the parents can expect. We can remind them that parenting is hard, but their struggles are normal. When we better understand parents, they can better understand us.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

Doctors talk more than they listen, especially when discussing end-of-life care with families, a recent study in Pediatrics suggests. Researchers from the University of Amsterdam followed 27 physicians and 37 parents as they navigated the difficult waters of end-of-life decision making for their children. By analyzing recorded conversations, they found that physicians spoke 67% of the time, while parents spoke only 30% of the time and nurses 3%. Additionally, they found that physicians “focused primarily on providing medical information, explaining the preferred course of action, and informing parents about the decision being reached by the team”(Pediatrics 2015;135:e465-76). Although parents were present during discussions, they were not routinely part of the decision-making process.

While this study was performed in Amsterdam and may not perfectly reflect the cultural norms of the United States, the results still should give us pause and raise important questions. Do we spend too much time talking, and too little listening? What role do parents have in decision making in our own country? Although we all participate in family-centered rounds, how often are the parents present but not involved? Do we pause often enough to explain in plain English what we had just rattled off in medicalese?

The challenge of listening is that it takes time and energy. With many other patients to care for and a long list of notes and orders to be entered, spending more time listening to families can seem exhausting and less important. However, this is the crux of the physician-patient relationship, and this is what makes the role of physician so important. When sick children and their families are at the most vulnerable point in their lives, it is our presence as empathizing, listening humans that matters most. Treating the disease with the correct medications is important but insufficient. And the sicker the patient, the higher the stakes.

As medical trainees, we often can feel powerless in these high-intensity situations. Yet, we can play a key role by advocating on behalf of our patients and their families, by giving them a voice. We can do this only by taking time to ask questions and to listen. After spending a few more minutes with these families in need, we can better understand their hopes and values, and we can identify the ways in which our goals align. As our medical teams are zipping through family-centered-rounds, we can advocate for families by raising their questions and concerns, ensuring that their voices are heard. By taking time to listen, we can provide that pivotal bridge of understanding between the medical team and the family.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

Doctors talk more than they listen, especially when discussing end-of-life care with families, a recent study in Pediatrics suggests. Researchers from the University of Amsterdam followed 27 physicians and 37 parents as they navigated the difficult waters of end-of-life decision making for their children. By analyzing recorded conversations, they found that physicians spoke 67% of the time, while parents spoke only 30% of the time and nurses 3%. Additionally, they found that physicians “focused primarily on providing medical information, explaining the preferred course of action, and informing parents about the decision being reached by the team”(Pediatrics 2015;135:e465-76). Although parents were present during discussions, they were not routinely part of the decision-making process.

While this study was performed in Amsterdam and may not perfectly reflect the cultural norms of the United States, the results still should give us pause and raise important questions. Do we spend too much time talking, and too little listening? What role do parents have in decision making in our own country? Although we all participate in family-centered rounds, how often are the parents present but not involved? Do we pause often enough to explain in plain English what we had just rattled off in medicalese?

The challenge of listening is that it takes time and energy. With many other patients to care for and a long list of notes and orders to be entered, spending more time listening to families can seem exhausting and less important. However, this is the crux of the physician-patient relationship, and this is what makes the role of physician so important. When sick children and their families are at the most vulnerable point in their lives, it is our presence as empathizing, listening humans that matters most. Treating the disease with the correct medications is important but insufficient. And the sicker the patient, the higher the stakes.

As medical trainees, we often can feel powerless in these high-intensity situations. Yet, we can play a key role by advocating on behalf of our patients and their families, by giving them a voice. We can do this only by taking time to ask questions and to listen. After spending a few more minutes with these families in need, we can better understand their hopes and values, and we can identify the ways in which our goals align. As our medical teams are zipping through family-centered-rounds, we can advocate for families by raising their questions and concerns, ensuring that their voices are heard. By taking time to listen, we can provide that pivotal bridge of understanding between the medical team and the family.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

Doctors talk more than they listen, especially when discussing end-of-life care with families, a recent study in Pediatrics suggests. Researchers from the University of Amsterdam followed 27 physicians and 37 parents as they navigated the difficult waters of end-of-life decision making for their children. By analyzing recorded conversations, they found that physicians spoke 67% of the time, while parents spoke only 30% of the time and nurses 3%. Additionally, they found that physicians “focused primarily on providing medical information, explaining the preferred course of action, and informing parents about the decision being reached by the team”(Pediatrics 2015;135:e465-76). Although parents were present during discussions, they were not routinely part of the decision-making process.

While this study was performed in Amsterdam and may not perfectly reflect the cultural norms of the United States, the results still should give us pause and raise important questions. Do we spend too much time talking, and too little listening? What role do parents have in decision making in our own country? Although we all participate in family-centered rounds, how often are the parents present but not involved? Do we pause often enough to explain in plain English what we had just rattled off in medicalese?

The challenge of listening is that it takes time and energy. With many other patients to care for and a long list of notes and orders to be entered, spending more time listening to families can seem exhausting and less important. However, this is the crux of the physician-patient relationship, and this is what makes the role of physician so important. When sick children and their families are at the most vulnerable point in their lives, it is our presence as empathizing, listening humans that matters most. Treating the disease with the correct medications is important but insufficient. And the sicker the patient, the higher the stakes.

As medical trainees, we often can feel powerless in these high-intensity situations. Yet, we can play a key role by advocating on behalf of our patients and their families, by giving them a voice. We can do this only by taking time to ask questions and to listen. After spending a few more minutes with these families in need, we can better understand their hopes and values, and we can identify the ways in which our goals align. As our medical teams are zipping through family-centered-rounds, we can advocate for families by raising their questions and concerns, ensuring that their voices are heard. By taking time to listen, we can provide that pivotal bridge of understanding between the medical team and the family.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

It is a busy night in the emergency department, and patients are lining up in the waiting room. The next patient is a 2-year-old boy with a cough, runny nose, and increased work of breathing. My stethoscope picks up a chorus of noises in his lungs, but no wheezes. The attending physician walks into the room with me, a pediatrics resident, and the mother looks on expectantly, hoping I will make her baby better.

The attending agrees with me, this child is doing poorly and needs to be admitted. Then the question comes: “What do you want to do for him?” A few minutes later, the patient is receiving an albuterol treatment. Unsurprisingly, he does not improve, but soon he disappears off to the floor and I move onto the next patient.

In medicine, the urge to help patients drives physicians every day. The true challenge comes when the only way to help patients is by doing less. In 2014, the American Academy of Pediatrics released new bronchiolitis treatment guidelines. In this document, they cited numerous studies showing lack of benefit from albuterol or racemic epinephrine treatments, and they recommended against treatment trials in children with bronchiolitis. Additionally, they recommended against X-rays and steroids. This leaves pediatricians with the unsatisfying options of suctioning, watching, and waiting.

Physicians tend to be “fixers” by nature. Patients come to us to feel better, and we feel driven (internally and externally) to provide these cures. This desire can drive us to prescribe antibiotics for presumed viral infections, order imaging for minor head injuries, or offer trial bronchodilators in the setting of bronchiolitis. As medical trainees, we have the additional onus of answering to our attending physicians. Perhaps we are willing to watch a patient with bronchiolitis slowly evolve, but maybe some of our supervisors are not. How firmly do we stand our ground? What authority do we have?

Perhaps we have more to offer than we think. As trainees, we are exposed to education and updates from diverse fields of pediatrics, and this developing knowledge base can benefit our medical teams. We can utilize our knowledge of neurology to abort a seizure on the oncology floor. We can guide the evaluation for anemia while at an outpatient clinic. And we can apply our awareness of bronchiolitis guidelines to patients in the ED. By continuing to develop and apply an evidence base for our medical practice, we can provide meaningful insights about which interventions should (or should not) be done for our patients. Although uncomfortable at times, such situations provide us with the opportunity to improve medical practice while protecting our patients from unintended harms, gently remind our attending physicians which interventions should (or should not) be done for our patients. With education and a bit of spine, we can help our medical teams to follow that foremost of imperatives for the medical profession: Primum non nocere – First do no harm.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

It is a busy night in the emergency department, and patients are lining up in the waiting room. The next patient is a 2-year-old boy with a cough, runny nose, and increased work of breathing. My stethoscope picks up a chorus of noises in his lungs, but no wheezes. The attending physician walks into the room with me, a pediatrics resident, and the mother looks on expectantly, hoping I will make her baby better.

The attending agrees with me, this child is doing poorly and needs to be admitted. Then the question comes: “What do you want to do for him?” A few minutes later, the patient is receiving an albuterol treatment. Unsurprisingly, he does not improve, but soon he disappears off to the floor and I move onto the next patient.

In medicine, the urge to help patients drives physicians every day. The true challenge comes when the only way to help patients is by doing less. In 2014, the American Academy of Pediatrics released new bronchiolitis treatment guidelines. In this document, they cited numerous studies showing lack of benefit from albuterol or racemic epinephrine treatments, and they recommended against treatment trials in children with bronchiolitis. Additionally, they recommended against X-rays and steroids. This leaves pediatricians with the unsatisfying options of suctioning, watching, and waiting.

Physicians tend to be “fixers” by nature. Patients come to us to feel better, and we feel driven (internally and externally) to provide these cures. This desire can drive us to prescribe antibiotics for presumed viral infections, order imaging for minor head injuries, or offer trial bronchodilators in the setting of bronchiolitis. As medical trainees, we have the additional onus of answering to our attending physicians. Perhaps we are willing to watch a patient with bronchiolitis slowly evolve, but maybe some of our supervisors are not. How firmly do we stand our ground? What authority do we have?

Perhaps we have more to offer than we think. As trainees, we are exposed to education and updates from diverse fields of pediatrics, and this developing knowledge base can benefit our medical teams. We can utilize our knowledge of neurology to abort a seizure on the oncology floor. We can guide the evaluation for anemia while at an outpatient clinic. And we can apply our awareness of bronchiolitis guidelines to patients in the ED. By continuing to develop and apply an evidence base for our medical practice, we can provide meaningful insights about which interventions should (or should not) be done for our patients. Although uncomfortable at times, such situations provide us with the opportunity to improve medical practice while protecting our patients from unintended harms, gently remind our attending physicians which interventions should (or should not) be done for our patients. With education and a bit of spine, we can help our medical teams to follow that foremost of imperatives for the medical profession: Primum non nocere – First do no harm.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].

It is a busy night in the emergency department, and patients are lining up in the waiting room. The next patient is a 2-year-old boy with a cough, runny nose, and increased work of breathing. My stethoscope picks up a chorus of noises in his lungs, but no wheezes. The attending physician walks into the room with me, a pediatrics resident, and the mother looks on expectantly, hoping I will make her baby better.

The attending agrees with me, this child is doing poorly and needs to be admitted. Then the question comes: “What do you want to do for him?” A few minutes later, the patient is receiving an albuterol treatment. Unsurprisingly, he does not improve, but soon he disappears off to the floor and I move onto the next patient.

In medicine, the urge to help patients drives physicians every day. The true challenge comes when the only way to help patients is by doing less. In 2014, the American Academy of Pediatrics released new bronchiolitis treatment guidelines. In this document, they cited numerous studies showing lack of benefit from albuterol or racemic epinephrine treatments, and they recommended against treatment trials in children with bronchiolitis. Additionally, they recommended against X-rays and steroids. This leaves pediatricians with the unsatisfying options of suctioning, watching, and waiting.

Physicians tend to be “fixers” by nature. Patients come to us to feel better, and we feel driven (internally and externally) to provide these cures. This desire can drive us to prescribe antibiotics for presumed viral infections, order imaging for minor head injuries, or offer trial bronchodilators in the setting of bronchiolitis. As medical trainees, we have the additional onus of answering to our attending physicians. Perhaps we are willing to watch a patient with bronchiolitis slowly evolve, but maybe some of our supervisors are not. How firmly do we stand our ground? What authority do we have?

Perhaps we have more to offer than we think. As trainees, we are exposed to education and updates from diverse fields of pediatrics, and this developing knowledge base can benefit our medical teams. We can utilize our knowledge of neurology to abort a seizure on the oncology floor. We can guide the evaluation for anemia while at an outpatient clinic. And we can apply our awareness of bronchiolitis guidelines to patients in the ED. By continuing to develop and apply an evidence base for our medical practice, we can provide meaningful insights about which interventions should (or should not) be done for our patients. Although uncomfortable at times, such situations provide us with the opportunity to improve medical practice while protecting our patients from unintended harms, gently remind our attending physicians which interventions should (or should not) be done for our patients. With education and a bit of spine, we can help our medical teams to follow that foremost of imperatives for the medical profession: Primum non nocere – First do no harm.

Dr. Sisk is a pediatrics resident at St. Louis Children’s Hospital. E-mail him at [email protected].