Etiquette-Based Neonatology

Keir A: “Please call my baby by her name…”. Acta Paediatrica 2013. This should be self-evident, but this publication in the Acta Paediatrica ‘different view’ section notes that it is not. Knowing whether the baby is a boy or a girl, and knowing their name (if the parents have decided on one) looking the parents in the eye when you talk to them, should we really have to teach doctors to do those things? I guess we do. Annie and I with Barb Farlow have written a review article about making difficult decisions in the NICU that should be published shortly, as a little taster, here is one part of our recommendations for communicating with parents about difficult issues. (As usual this was Annie’s list initially, ‘etiquette based neonatology’, is her copyrighted term for it). The following is a section quoted from the upcoming article.

When you talk to parents:

‘-Limit the number of Health Care Providers attending difficult conversations or complicated deliveries.

-Make sure you do not get interrupted: ask a colleague to cover the delivery room or take your pager.

-A baby is not a “23-weeker” or “a difficult case of NEC”. If a baby has a name, you should know it and use it.

-Have difficult conversations in a place that is suitable for the parents.

-Do the parents want a significant support person present? Wait for that person if time permits.

-Introduce yourself to the parents.

-Explain your role in the team caring for their baby and why you are there.

-Sit down for difficult conversations.

-Listen more than you talk; tolerate silence.

Some may sigh and find this list is obvious and patronizing. Experiences of parents show, however, that these basic human interactions may be neglected

(Janvier A, Farlow B, Wilfond BS: The Experience of Families With Children With Trisomy 13 and 18 in Social Networks. Pediatrics 2012.)’

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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5 Responses to Etiquette-Based Neonatology

  1. Thanks for this reminder. Very well written by Dr Janvier and B. Farlow.

  2. I completely agree with Katharina. This is a very good reminder for us all. Thanks for posting this Keith.

  3. Sue Merkley says:

    I work with a group of Amazing Neonatologist, Bob Connelly being one and I have personally witnessed him in many “tough discussion” situations and have yet to see a more professional approach than him. The above mentioned “etiquette based neonatology” tips were very professionally applied in every situation so I see the importance of educating ALL in this skilled and extremely important part of what you do. I look forward to reading the article and thanks Keith for your ongoing posts and thought provoking topics

  4. D says:

    My obstetrician called my 28 week premature daughters “little rats”. I was in total shock. I couldn’t even respond!! That was 14 years ago and I remember it like it was yesterday:( He was such an arrogant ass!! Our neonatologist, paediatrician and nurses were amazing tho:)

    • DOCs in any specialty can be arrogant, and insensitive and lacking compassion. Fortunately in my experience, most are caring people, who sometimes lack the tools or the insight to give the best support to the families they serve. Most Obstetricians are in the field because they care about women and babies, I think your experience (I hope) is rare. On the other hand failing to do some of the things in the above list is fairly common.
      I never had any training in how to communicate with parents, and learnt ‘on the job’ I think we can make parents much more satisfied with the interactions with their babies’ doctors if we take more care to teach good communication skills, which obviously includes avoiding prejudicial terms like ‘little rats’.

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