Spitzer’s rules

Alan Spitzer is a name well known to most neonatologists.  For several reasons: he has been a vital force in neonatology for many years, he is one of those good-natured, but intellectually rigorous physicians that neonatology has been blessed with. He also created many years ago a list of Spitzer’s rules of neonatology, that were recently challenged by a tongue-in-cheek study by my good friend Tony Ryan. To which he responded.

 After our recent article about etiquette in the NICU, Alan wrote to us about his own personal experiences on the receiving end of NICU care, the details of how it came about are his to tell if he wishes, but I asked him for permission to quote his additional rules of neonatal etiquette, which he granted.

So here, with gratitude to Alan, are some supplemental rules of etiquette for NICU docs.

1) Don’t disappear when I need you the most. Many physicians seem to become increasingly unavailable when the situation is complicated or unclear. That is when families need a physician to be most available to discuss changes in clinical condition, options for treatment, or likely prognosis. The worse the situation is, the more that you need to make yourself visible and present for a family in crisis.

 2) When parents appear with a wealth of material that they have located on the Internet, do not immediately dismiss it as rubbish. Some of it might be quite valuable and appropriate for the situation. More importantly, by briefly reviewing the information with the family, you validate them as your partners in the care of their infant and enhance your relationship.

3) If a parent is medically trained, do not assume that they need no detailed explanation of the infant’s situation. They may actually need more information from you than the usual family, since they may have an entirely different set of concerns that need to be addressed, generated from their prior medical experiences.

4) In times of difficult decisions, talking out loud to families and letting them see your thought processes are often helpful approaches. In complex situations, parents may wonder if you have evaluated all the possible options or truly understand what is going on with their infant. By letting them see how you are evaluating the situation in your own mind, you may greatly reassure them, since they will immediately perceive the broad scope of your thought processes. Nothing is more disconcerting to a family than wondering if their child’s doctor has overlooked something, nothing is more reassuring than to know that he or she has not only considered that issue, but many more possibilities.

5) Never, ever be curt, rude, or patronizing, no matter how demanding or confrontational a family may be. When a family persists with this kind of behavior, it is likely that you have not addressed their critical concerns and that is why they are so frantic. By directly asking them to tell you what is troubling them may reveal issues that will quickly allow you to put their minds at ease.

Thank you Alan for these insights!

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research. Bookmark the permalink.

2 Responses to Spitzer’s rules

  1. Ahmed Moussa says:

    Thank you for these great messages! I hope that physicians in all fields and trainees will be inspired by them.

  2. olaandersson419 says:

    For many years, I had Spitzer’s rules on the wall of my office, I suppose to remind me to stay humble in the face of ever changing circumstances in the NICU.
    Just like the points in your article on etiquette in the NICU, these are very important points. I hope to remind my colleagues, fellows and residents of them from here forward.

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