Compassion in Pediatrics

This week, on Tuesday, I had to take my kids to the dentist. I have existential dread about this appointment every 6 months. Since Covid, the practice we use requires that all children in one household come to the same appointment. This is so they can clear out the other chairs to prevent sharing germs, and I really appreciate the thoughtfulness behind that decision. However, I also kind of hate it, because when one of my kids is screaming about his perceived loss of bodily autonomy (aka having to open his mouth for the dentist), then the other one starts screaming because his brother is upset, and then we are in a destructive spiral of kids who won’t calm down. I start sweating just thinking about it. I had been dreading this appointment ever since I wrote it on my calendar.

The first time we went to this dentist, it was a dumpster fire. Both boys opened their mouths, but no teeth were brushed, no fluoride was applied, and everyone had a meltdown. The dentist seemed annoyed, but the hygienist was kind. He suggested (and somehow I heard him under all the racket) that I talk to both boys about what might happen at their next dentist appointment. He and I agreed on some verbiage that I would use to prepare them and that he would use at their next visit. He recommended I use a metal spoon to pretend to count their teeth at home, so they wouldn’t be afraid of the mirror used in dental appointments. As we left that first time, tears streaming down both boys faces, he told them they were very brave, and he gave them each their stickers and tooth brushes anyway. Desperate for my kids to be more agreeable next time, we played “dentist” every few weeks. Preceding this week’s appointment, I talked to them about what to expect, we practiced on their toys, and I followed the hygienist’s instructions.

At this week's appointment, something magical happened. The boys had that same hygienist, named George, for their dentist appointment. He remembered us from our first visit (probably he is scarred for life), and rather than matching our dread, he smiled, and told the boys he was glad to see them. He spoke to them directly the entire time and thanked them for coming to see him. He asked my oldest to hop up in the big boy chair, and he spent time showing my son the little components of the electric toothbrush. They laughed about how tiny the brush head is, and George demonstrated how the brush feels on my son’s hand before he asked my son to lay down and open his mouth. George spoke to him like a person, gave him clear expectations about what was going to happen every step of the way, let him take breaks to get up and move his body, and congratulated him for successfully completing every step of the tooth cleaning. My son felt proud, and he ran to the bathroom to admire his "very sparkly teeth".

Then, when the dentist came to inspect the kids’ teeth and apply fluoride, George took a moment to coach the dentist. He told the dentist which words to use (paint your teeth vs. apply fluoride), and praised the kids audibly for their clean teeth and bravery. He also recommended to the dentist that we skip x-rays to allow the kids to have a completely successful visit. And, perhaps most amazingly, the dentist listened to 100% of George’s recommendations. We were in and out of the dentist with zero meltdowns, zero tears, both kids feeling proud, and both kids with clean teeth. I was amazed, thankful, and felt like I had witnessed a miracle! George demonstrated truly compassionate care, and the results were immediate and effective. He built trust, communicated clearly, and respected his patients’ needs for taking breaks and wiggling. He never talked down to them, and he only provided positive encouragement/reinforcement. I’ve been thinking about this experience since Tuesday, and I still feel overwhelming gratitude and appreciation when I think of the kindness shown to my kids.

It shouldn’t be this surprising to encounter compassionate care, and I, as someone who truly believes in the transformative power of compassion, should really not be so surprised to see its effectiveness in action. One systematic review about pediatrics emphasizes that compassionate care for children needs to include continuity of care, clear communication, and coordination of care[1]. Unfortunately, of all 29 papers included in the review, none actually asked patients or patient family members about whether they felt their care was compassionate, so it’s hard to say for certain whether these three components are as necessary as researchers believe. However, in my recent personal experience with George, I agree 100% that continuity of care and communication/expectation setting are critical components of compassion in pediatrics. Kids need to trust their providers, and when providers are able to recruit parents in expectation setting, trust can be built. Kids feel safe when expectations match reality.

I think, also, that these ideas should not be limited to pediatrics. Adults also feel safer with a provider they know and trust, who communicates clearly and tells the truth, and coordinates the messaging and the plan with other necessary parties. As medical providers, we all went into our respective fields in order to help people. At some level, we probably all imagined ourselves behaving like George - connecting with our patients, empowering them to act bravely for their own benefit, and taking care of other humans. If we can stay in touch with these ideals, and advocate that our professions value the healing power of connection, lives will be changed for the better. I know that, in my house, we will never forget George.

[1] Compassion in Pediatric Healthcare: A Scoping Review. Sinclair, S., Kondejewski J, Schulte F, Raffin-Bouchal S, Guilcher G, Strother D.