Many pediatric neurosurgeons feel a sense of calling for this subspecialty. Along the way, we encounter many challenges unique to this field related to working with children and their parents or guardians. Patients and their families must place their trust and life in our hands. Building trust can lead to meaningful surgeon-patient relationships but can also be difficult, particularly in early career stages. I have been fortunate to have excellent senior colleagues who have provided wisdom and support while navigating these obstacles, and this is my attempt to share some advice.
One unavoidable situation involves being asked, “How many of these have you done (procedure)?” or “How long have you been doing this?” Preparation and practice allow for a confident and reassuring response. Early in their careers, two of my peers gave me their perspectives on these shared experiences. They navigate this situation by detailing their years of medical school, neurosurgery residency and fellowship training, emphasizing that the procedure has been performed by them before. Rare conditions can be slightly more challenging. In these cases, I believe in honesty and transparency. Informing the parents of discussions with senior mentors or plans to have surgical assistance from a trusted colleague can be helpful. Having integrity will build trust.
Despite your best effort, the family might ask for a second opinion. As disappointing as this may be, remember that they might feel guilty; requesting another evaluation is their way of protecting their child. We should encourage parents to have comfort in, and derive confidence from their decision. In some situations, I have discussed cases with senior colleagues for expert insight, sharing this information with patients’ parents; this communication often times reassures them in their decision to pursue care with me. In other situations, I have been the primary caregiver, but have utilized a surgical assist from a senior colleague. In other situations, a transfer of care was in everyone’s best interest. Fostering respectful and collaborative relationships with colleagues can make these situations more manageable. When arranging for an outside second opinion, offering to see the patient again for a follow-up visit to review options is an excellent way to maintain open lines of communication and support. In the majority of cases, you will remain the treating surgeon.
Another unique aspect of pediatric neurosurgery is delivering bad news to parents. No matter the circumstance, it is never easy and often devastating. Losing a child is something that no one ever wishes to experience. It is our privilege and duty to help families through difficult times like these. We should be kind and patient while supporting them through their shock and grief with calmness and empathy. A study by Granek et al., using qualitative research methods (Grounded Theory Method), interviewed 26 pediatric neurosurgeons across 12 countries to evaluate the distinctive features of the surgeon-patient/family relationship. Interesting themes such as “relational attachment to patients,” “forming bonds with the parents/caregivers,” “dealing with patient suffering, death and complications,” and “communicating bad news” were highlighted. The authors also conclude that fellowship programs should include specific training on delivering bad news. Even with training and preparation, the weight of this responsibility can sometimes feel overwhelming. My advice is never to hesitate to seek help from a mental health professional and trusted colleagues.
Lastly, here are a few extra pieces of advice that will help you develop unique relationships:
- Listen to caregivers and patients with full attention. Resist the urge to interrupt.
- Tell the truth. If you need to be more current on the data, be honest and follow up after searching the literature.
- Know your limits. Ask for help when needed. Review your complications and learn from them.
- Be a nice human. Care for all patients, no matter who they are or where they come from.
And remember, you have the best job in the world. With time, these challenges will be so minuscule compared to the tremendous impact of being a pediatric neurosurgeon.
