Each morning as I sit on my deck drinking my coffee, I am privileged to watch the behavior of many bird species, and observe their approach to parenthood (among other things).
I see many parallels between this behavior in the wild and the approach to parenting I sometimes see in mothers and fathers of children admitted to the hospital.
OK, so you are thinking I am a little bit nuts, and perhaps that is true. But when you are always looking for topics about which to blog, this kind of thing happens not infrequently. So humor me, and see what you think about this metaphor when I am done.
Every day for the past few mornings I have observed (and heard) a female Mockingbird aggressively defending her nestlings when any real or imagined predator has wandered a bit too close for comfort. Not content to remove them from the immediate vicinity, she doesn't stop chasing them through the neighborhood until they fly away deep into the woods. Even then she continues hollering at them (and anyone else foolish enough to come close) as a warning of just how protective she is and will be. I even saw her exhibit this behavior while fighting three crows simultaneously, seemingly with little concern for her own welfare. At the end, she was victorious, the crows left, complaining all the while, and she returned quietly to her nestlings after shouting out her victory for all to hear.
Compared to the behavior of Ms. Mockingbird, I have observed closely the pair of Eastern Bluebirds who nest in a man-made nestbox nailed to the lower level of my deck. I check the nestbox frequently, reporting information about it to the Cornell University Lab of Ornithology. The Bluebirds are attentive parents, and when there are eggs or young in the nest they always stay close. However, they fly off whenever they see or hear something unusual, and certainly whenever I approach the nest site. They will sit on a tree branch close enough for them to watch me, but far enough to stay out of my reach, in case I intend to do them harm. They sit there and sing to me, imploring me (or so I imagine) not to do harm to their offspring.
Of course I am a friendly predator, and only open the nest box a little to check on the eggs or the hatchlings, and leave some food (meal worms, anyone?) nearby.
A few minutes after I go back in the house, one or both of the parents will fly to the nest to check on the contents, and usually the female will then stay inside for at least several minutes, depending upon whether it contains eggs or hatchlings.
Then there are the Brown-headed Cowbirds. These appear (if we can anthropomorphize a bit) to be quite trusting, at least when it comes to the incubation of eggs and feeding and rearing of their young. Cowbirds don't make a nest, but they run (fly) around finding other nests in which to lay their eggs. They lay ALOT of eggs, because not all of them will be accepted by their involuntary foster parents. What I have observed at my feeders is a couple of families of house finches who come to feed as a group, bringing their young with them. Some of these family groups have one juvenile who is much bigger than the others, and clearly represents a baby Brown-headed Cowbird. Usually I see the mom and dad Cowbirds in the vicinity, often at the feeder at the same time, but making no attempt to feed their own youngster, who is monopolizing the attention of the (usually) male housefinch, begging to be fed, and eating twice as much as his foster siblings.
OK, so even if this is of mild interest to you, what does it have to do with doctoring, or patients, or their parents?
Well, one of my points is that in nature there doesn't seem to be one "best practice" of parental behavior and child rearing. All three approaches seem to work, at least for the birds. The other point is that we, as physicians, often expect parents to behave in certain ways, generally consistent with our own values, beliefs and experiences.
So, lets take the Mockingbird.
How many times have we, as physicians become distressed because a mother or father of a hospitalized child seems always to be "on the offensive?" Often (in my experience) these are parents of kids with chronic or congenital conditions, who have had numerous admissions, may have been the recipient of previous medical errors, or may have simply just had a prior bad experience with the medical system.
Our students and residents and less experienced physicians may take the Mockingbird behavior personally, and become defensive.
This only enrages the Mockingbird parent even more, because they perceive a lack of team, a lack of acknowledgement of their role in the healthcare of their child. The most beloved and trusted physicians are those who have been able to form a partnership with the Mockingbird parent, who acknowledge the fear and uncertainty they feel when faced with a new set of healthcare providers, and who treat them with the respect and understanding they deserve--oh, and who refuse to allow themselves to be chased out of the neighborhood.
The other type of parent or guardian that healthcare providers tend not to "like" is the Cowbird. We tend to be suspicious of anyone who would leave their child in the hospital on their own, who would pursue their own interests while someone else tends to the needs of their child in the hospital. We may misinterpret a high degree of trust for lack of interest. We may not have taken the time to understand why the Cowbird parent only "checks in" from time to time, instead of sitting obediently at the bedside waiting patiently to be there when and if the members of the healthcare team want to share information. We may not know that the Cowbird parent has a large number of other children at home, might be a single parent, or has a job from which he or she might be fired if too many days are missed. Many inexperienced physicians can interpret this lack of presence as lack of caring, and may fail to make the attempt to communicate with the Cowbird parent.
Finally, the Bluebird.
In my experience most of us find the Bluebird parent to be the epitome of "perfection." Always close by but never aggressive. Always willing and able to provide bedside care, but never in the way. Generally the Bluebird parent is less likely to argue with healthcare providers, and more likley to take our advice, or agree to whatever test or treatment we have suggested. They may ask questions but are always polite. These are the parents who say thank you every day, they make us feel good when we go in the room, so we want to go in more often, spend more time with Mr. and Ms. Bluebird, AND their offspring.
Which parenting approach (with regard to a sick or hospitalized child) is best? If we take a clue from nature, we would have to say they are all effective approaches to continuation of the species. As physicians we need to understand that these differences exist (plus many others) and that it is not up to us to judge the validity of one over the other.
Now I am not suggesting that we tolerate child neglect, or condone parental behavior that is so aggressive as to be physically, verbally or psychologically threatening to healthcare providers.
But I am suggesting that we learn to understand the motivations of all parents, and find ways to partner with them in an effort to make ourselves most effective in treating illness and facilitating wellness in their children.
So what do you think? Am I crazy?
If you are a parent of a child who has ever been hospitalized or had to seek emergency care, do you see yourself as a Mockingbird, as Bluebird or as Cowbird, or have I completely missed the boat here?
Likewise, if you are a physician, a nurse, or other healthcare provider, do you recognize the different types of parents I have described here? Are there others I should have mentioned?
Remember, I am not a vet, I am not an expert in animal behavior and only know what I have personally observed. There may be other species that would fit the metaphor better.
I would love to hear any comments or stories you would like to tell.