Why are pediatricians so bad compared to adults' doctors?

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This thread reminds me of Taking Children Seriously (TCS), a website and a social movement. It means giving children as much personal agency as laws allow, and not treating them as baptized property or as two-legged pets.
Link: https://www.takingchildrenseriously.com/

Consider the difference between a TCS pediatric nurse and a conventional pediatric nurse.
RN = nurse
PT = patient

***** TCS pediatric nurse *****
RN: (warm, but serious) "Hello. My name is Jacqueline Feldman, but you can call me Jackie. I'm a Registered Nurse*. <briefly holds work badge at child's eye level> That's what 'RN' means. Do you have any questions?"
PT: "What are you going to do?"
RN: "I will give you a shot to help you stay healthy. I can't promise you that it won't hurt. But I can promise you to make it hurt as little as possible, and make it as quick as possible. Now, I want you to promise me something too."
PT: "What is it?"
RN: "I want you to promise that you won't move while I'm giving you the shot. If you move, that will make it hurt more than it needs to, and I don't want that. Crying is OK, screaming is OK, moving is not. <pause> Please uncover your arm."
PT: "OK, I promise." <reluctantly uncovers arm>
RN: "Thank you. It's coming now." <gives shot>
PT: "Ow! It hurts!"
RN: "I warned you that it would. Count slowly to five, and it'll be over."
PT: (whispering) "1... 2... 3... 4... 5..."
RN: <pulls out syringe> "It's over. You did wonderful." <gives congratulatory pat on shoulder>

***** age note *****
* For children under 6, full legal names and official job titles can be omitted, or replaced with simple descriptors like "nurse"; a name is still necessary for the humanization factor, though. But for older children, formality gives a touch of professionalism and respect, rather than an image of "a sadist in a lab coat".

***** conventional pediatric nurse *****
RN: (squeaky, patronizing tone) "Hi! I'm Jackie. I'm here to help you. I will make you nice and healthy."
PT: (apprehensive) "OK..."
RN: "I'm going to give you a shot. It won't hurt a bit."
PT: "I had shots before. They hurt."
RN: "This one won't. Now, sit still and uncover your arm. And don't move while I'm doing the shot!"
PT: <reluctantly uncovers arm>
RN: (aside to parent) "Aww, he's so scared. Just look at his eyes." <gives shot>
PT: "Ow! It hurts."
RN: "No, it doesn't."
PT: <submissively silent>
RN: <pulls out syringe> (squeaky, patronizing tone) "See? It wasn't so bad."

***** language note *****
In languages other than English that distinguish between formal and informal pronouns "you", it's best to use the informal "you" with a child. The formal "you" will feel confusing to a younger child, and come off as a patronizing cheap charade to an older child; conversely, it will feel flattering to a minor ages 16 and 17.

Scary side note:

Until 1987, babies and infants were operated on without anesthesia, because pediatricians (who I like to call "butchers in lab coats") believed that babies and infants don't feel pain. Anesthesia for that age group was introduced in 1988. But doctors continued believing that little kids don't feel pain until as recently as 1999. Which explains why all my pediatricians were garbage. The only reason nurses (general, not pediatric) treated me compassionately is that their job title is a calling, not a moneymaker. Which also explains my parents' and my pediatricians' callousness toward my pain in general, as they also believed that I "couldn't feel pain", and was just being a coward. Hence my parents taking away my cartoons as punishment.

As bad as Gen Z and Gen Alpha may be in terms of work ethic (notice the smiley!), I'm glad they're getting far more compassionate medical care as children than I could ever dream of!

Sources:
https://www.nytimes.com/1987/11/24/scie ... nally.html
https://www.newsweek.com/when-doctors-s ... in-1625350
https://en.wikipedia.org/wiki/Pain_in_babies

I think the worst thing about pediatricians is that they always find an opportunity to out/narc on the patient's fears to his/her parents, thus getting him/her in trouble at home, no matter how good the patient is otherwise. Case in point.

At my pediatric appointments...
* When I came and left, I was polite and respectful to everyone, from the receptionist to the doctor (M.D.) herself.
* I obeyed everyone's instructions and commands with 100% compliance, without even a slight a hint of resistance.
* I let them butcher me to their delight, not saying even "ow!". (Although I did groan and grunt from the pain.)

And yet... the minute they saw fear in my eyes, they ratted me out to my parents right in front of my face! Which made all my other efforts to be a "good" patient worthless. I suppose if I cursed out the receptionist, smashed the pediatrician with the chair I sat in, and stabbed the phlebotomist with the syringe she used on me, my end result would be just the same: I'd lose my cartoon privileges that night. Same as after skittishly sitting in the chair waiting to be butchered like a pig in a slaughterhouse, just having the "wrong" look in my eyes. And when I asked them technical questions, to learn more about their tools or the procedure being done, in order to mitigate my fears and "be braver", they laughed in my face, instead of just plain answering me!

WHY THE **** [SEX] DO THEY DO THAT?! After all, I never TOLD THEM I was afraid! What's the ****ing [sexing] difference did my eyes make? And they even laughed at me for asking questions! Scared or brave, I was still being a good patient to them and trying to act brave for my parents. And I still lost, just because some ***** [female dog] narc'ed on me about my "scared eyes"! If she kept her filthy mouth shut, my parent might not notice my fear at all, or if they did, I could find a way to plausibly deny being scared. ("No, I was brave; the exam lamp was just glaring in my eyes.") But no!


By contrast, doctors treating adult patients do none of that crap, whether the patient comes alone (like me) or with a caretaker/companion. Their simply pretend not to notice the patient's fear, unless the he/she speaks up or looks blatantly uncomfortable; or they address the fear without putting the patient's respect level with their family in harms way. In fact, since I've been to my regular hospital many times already, the nurses and doctors have gotten to know me by now, and we feel comfortable joking around with each other a little. I must extend gratitude to the poor nurses and techs putting my with barrage of questions; they do it like troopers. And if something they do hurts, you bet your *** [butt] I speak up loud and clear! (Although I joke more than they do, as I have more freedom as a patient.)

AGAIN, why are pediatricians so dumb about treating children, compared to doctors treating adults?

I think one reason pediatricians are horrible to kids is the same as why family therapists are horrible: their patient is not their customer, the patient's parents are! So pediatricians are there to satisfy the parents, not the patient. And since most parents care more about "being good parents" (read: "looking good in the general public's eyes") than about their child's pain level, the pediatricians act accordingly. Because capitalism.

As for outing the patient's fears ("aw, look, he's scared"), perhaps that's what the parents asked for. (Which I didn't realize as a pediatric patient.) Like, "If you see our kid acting scared, let us know on the spot! We're not going to be happy if we have a scared kid in a clinic; it's an embarrassment to us as parents!".

Conversely, when I come to my hospital, I'm the customer myself. I can be scared if I want to, and the pressure is on the nurses, the phlebotomists, and the machine techs to make the fear go away. How they do it, it's on them. I pay the medical bills, I treat them with respect when I'm there, the rest is their job.

It depends on the doctor. I had excellent doctors growing up I'm sorry you had a bad experience.

I don't remember being treated that way as a kid, even though I would be literally terrified when I had to get a shot or go through something else painful.

My doctors were callous and insensitive to me as a kid. After all, I wasn't their customer; my parents were. So my pain didn't matter to them. Therefore, no one really cared. The only person who was remotely sympathetic was my OR nurse (at age 10). But her powers were very limited; she couldn't order psychiatric or pain meds for me. All she could do was comfort me verbally.

My daughter's paediatrician and my son's as they had different ones we're both good. My daughter has come across two bad ones though but both were brief.

But here where I live at least its pot luck. I mean my dad's doctor couldn't diagnose a massive tennis ball size cancerous lump on his neck.... he went private in the end. I've had mainly good ones, minus when they couldn't diagnose sepsis for 48 hours and I saw lots of people in that time saying something was wrong.

Thinking about it when I had stitches in my knee as I fell over it was a normal doctor but god he sucked. No pain relief and wonder why I was screaming the place down. I have heightened pain

Sorry you felt mistreated, but not all pediatricians are the same. Both my kids, son and daughter, really really liked their pediatricians.

Consider that your parents likely felt most comfortable with, and thus choose, professionals whose demeanor and philosophies matched their own. If your parents were cold and callous, that is the type of professional they were able to respect and believe would be "good" for their child. The professionals you worked with in the emergency room weren't chosen by your parents; that option didn't exist, so maybe that is why the experience was different.

Last edited by DW_a_mom on 31 Oct 2022, 4:39 pm, edited 1 time in total.

Seriously, what kind of parent does that? Obviously yours did, but that is so far out of the norm that no pediatrician is going to anticipate it.

If what you're saying is true, then it proves my point: pediatricians work for the parents, NOT the patient. It's the customer/patient divide glaringly prevalent in family therapy also existing in pediatry. Which means: If the parents don't care about their child's pain---if not outright enjoy seeing it---and if they're looking for extra punishment opportunities for their child "acting scared", then that's what the pediatricians will deliver. In other words, they'll neglect pain minimization, and they'll out the patient's fears to the parents---because it's what the parents want. Anything the patient feels is irrelevant.

Conversely, I've been in and out of my local hospital over the last several months. All outpatient, but still a hospital. I was scared and skittish at first, but became jaded and desensitized lately. I was inside lots of treatment machines, and was poked with needles like a pin cushion. So there's little than can faze me now. But one thing for sure: if I acted as a child the way I acted at the beginning of my recent hospital ordeal, I'd have forgotten what a turned-on TV looks like by the time my punishment sentence had ended. But instead, I found my adult hospital experiences flat-out enjoyable.

The difference between what you've said and what I've said is that your perspective is destined to taint nearly all pediatricians, while mine acknowledges a few like that may exist, but it isn't all or even a majority.

All doctors exist to serve the needs of the patient. But doing so involves a lot of perception and judgement, and it can also require negotiating with parents who are adamant something else is in the best interests of their child, and have the ability physician shop to get the result they seek. Legally, unless there are clear signs of abuse or neglect, parents have the final say. No pediatrician has the ability to change that reality, although they'll usually do their best to sell their opinion. Ultimately, there are a lot of contributing factors to any one individual's experience.

I am glad that as an adult you've been able to communicate your needs effectively and access professionals able to comfortably serve them. I am sorry you did not get that as a child.

I thought it was the other way around. The general paediatrician I had during childhood was excellent and well liked. He kept a big glass cabinet of Warhammer minitures in his clinic. One time he even gave me a book (it was actually a really good book to, I read it multiple times).

A few years later he saved me from juvie when he wrote a letter to the judge.

The locum GPs I had during childhood (not pedeatritions) were fairly good natured as well. Even the doctors who saw me when I had to stay in hospital when I was 7 were nice (the nurses were generally unpleasant to me)

But the older I get, the more GPs act like a-holes. I had one GP for several years. One time I went to see him and he said "you should see your GP about this". Like, dude, you've been my GP since I moved to this neibhorhood 3 years ago.

The last straw came when he told me to "call him back at 6pm" to discuss some medical matter and then he got mad at me for calling him at 6pm. He told me to do that!

I don't see him anymore. I started going to another clinic with about 4 GPs but I don't really have a regular. They're mostly nice enough but they all feel a bit distant and aloof because I don't have a regular.

In this thread, "pediatricians" mostly refers to pediatric generalists. Now, mine were garbage, plain and simple, and so were the phlebotomists. They were basically butchers cutting up a pig in a factory farm. Lab techs were hit-or-miss, machine techs (like MRI operators) were excellent. Specialists were usually great, like my urologist, my ENT, and my bone-and-joint (I forgot the medical name for it). Except for my ophthalmologist---she was garbage like the generalists. I had an eye infection, and she put some kind of drops in my eyes; she said it was "water, to clean your eyes" , but it burned like she was putting in vinegar. So clearly, it wasn't water! And my parents berated me right there in the office for complaining.

I beg to differ: pediatricians exist to serve the needs of the patient's parents, NOT the patient; this includes outing the patient's fears to create punishment opportunities. But this brings me to a question: Who would pediatricians serve if conventional families didn't exist? Maybe all children live on the streets, maybe children are raised tribal-style by multiple random couples, maybe something else---don't worry about the semantics. Without a powerful set of parents to cater to, what would pediatricians do? Would they legitimately cater to the patients themselves, or would something else happen?

Yet between you and me, I'm the only one who has had conversations with a pediatrician as a parent, with the pediatrician telling me point blank if they felt my decision was not in the best interests of my child's health. They were legally bound to my choices (absent pretty difficult bureaucratic proceedings), but they weren't all that interested in keeping me happy when they felt I was doing wrong by my child. Didn't happen often given that I actually listen to both the doctors and my children, and willingly stepped back when they want to communicate directly with my child feeling privacy would get them a more complete and honest answer.

Which renders your question moot, really, but I suppose the doctors would be accountable to written guidelines or a pediatrics board, and not a parent's judgement. The problem here is that children do not have the fully formed brain capacity to weigh complex medical decisions, and most medical decisions involve some level of judgement call. Some adult has to have final authority on those judgement calls.

I actually involved my kids in nearly all decisions regarding their medical care, past a certain age at least, but most of the times I could feel the weight of it on them, and they would tell me to decide. Still, I am a huge believer in instinct, that we all have subconscious knowledge about what goes on in our bodies, and I wanted to find a way to tap into that, to know what their instincts were telling them. But its an awful lot for a young brain to process, it really is. That is why the responsibility falls to the parent.

I made millions of decisions for my kids every day. Some good, some bad. There are no perfect parents, only human ones. But I took my responsibility to them seriously, and their doctors took their responsibility to them seriously. My kids, now grown, know enough now to feel grateful for their parents, even if we did make some pretty glaring errors. I know there are a lot of bad parents out there, but the world isn't actively conspiring against kids.

I like those ideas. I think neutral third-party agencies and/or top-down guidelines would do a lot of good for pediatric patients. Things like requiring minimum anesthesia levels for procedures, providing pamphlets explaining things at a child-friendly reading level, regulating bedside manners, etc. At status quo, pediatric healthcare is inferior to adult healthcare. With just parents at the helm, biases can creep in, like parents thinking their child's pain isn't as bad as it actually is, and that their child is "whining". And some pediatricians enable such mindsets, by narc'ing on the child's fears or by being overly harsh with the child.

Even if everything else is "all in my head" or bad luck of the draw, one thing is absolutely true: other than in emergency rooms (which aren't age-specific), pediatric anesthesia sucks! It's basically glorified aspirin and benadryl, compared to what adults get (valium, propofol, and/or fentanyl in my case). As a result, children's surgeries end up being far more painful than they need to be, and in case of general anesthesia, post-wakeup pain is often excruciating. I remember waking up with a smile on my face after my surgery this year with no trace of pain, and complaining about the ceiling being the wrong color. (They moved me from the OR to the PACU while I was under.) As a child, I cried from the pain after waking up, and was in pain for days.