Staying human in the medical family: the unique role of doctor-parents

There has been an evolution in parental leave provisions in some parts of the world, particularly in Canada. Recently, the federal government began to provide 15 weeks of maternity leave and 35 weeks of parental leave (including adoption leave), for a total of 50 weeks of support. In Ontario, an agreement between the Ontario Medical Association and the provincial government provides for 17 weeks of maternity benefits for doctors not eligible for federal funding. Since its inception in 2000, over 900 doctors have taken advantage of the program, which has cost $11.2 million. Calls for paternity and adoptive leave have been less successful.

In general, doctor-parents have unique access to health information and knowledge. They are also trained in assessing normal and abnormal development in children. Most have strong career demands. Some need to carefully balance their public versus private roles (depending on the type of clinical work they practice) and their role in the community. Many work longer hours than most parents, including on-call demands. Many are self-employed, without benefits, and need to ensure that they set up and monitor financial safeguards. Finally, sources of rebellion, confusion, and tension can be unique to doctor-families as children gain insight into the elements of medicine that interfere with their ideal family life.

Doctor-parents are often high achievers. They seem to be under-represented in the health consumer population, possibly because of their awareness of health promotion and disease prevention strategies. However, there are reports of doctor-parents having reduced quality time with their children, feeling guilt and remorse over their limited parenting roles, and having different attitudes towards childcare and rearing depending on their gender.

Many doctors report that their long work hours result in reduced contact with their children, particularly if they leave home before their children rise, and/or arrive home close to bedtime. This appears to be a common regret, with some doctor-parents feeling it is too late to learn how to communicate with their children.

On-call duty is a common source of tension within doctor-families. Some doctors set their pagers to remind them to make a good-night phone call, while others leave a note in the bathtub, under the pillow, or next to an evening snack. Children of these doctors tell us such gestures send a strong and positive message.

Some doctors who come to us about family problems report that they didn’t recognise the red flags of poor communication, and encourage us to emphasise that lack of spontaneity, silent shared time, or hearing of problems through others should raise a doctor-parent’s concerns and prompt intervention.

Doctors’ children have emphasised their need to be able to contact their parents directly in a time of urgency. Yet, they feel uncomfortable asking for this, as they know how busy work is for their doctor-parents. Ensuring that children know clinic or hospital staff (particularly assistants or secretaries) is felt to be helpful, and some families have established a code word or phrase that sends the message that the doctor-parent is required urgently. Several doctors have taught their children how to responsibly page or email them, or carry a beeper or mobile phone just for their children to access.

Most parents have a healthy fantasy of how they want their children to grow and develop. However, some doctor-parents have disclosed to us that they wished they had been more careful in the expectations they projected onto their children. Some have made the link between being part of a profession that attracts perfectionism, dedication, determination, and obsessiveness, and subsequently expecting their children to follow a competitive path of education and training, enter a profession of parental choice, or engage in activities that meet parental approval.

Doctor-parents also report that the combination of work and home responsibilities contributes to isolation from the broader community. A useful intervention has been to help the doctor find time to reconnect, gain support from other parents, access recreational resources, and develop insight into their children’s development outside the home.

Doctor-parents, like all parents, need access to competent general practitioners and paediatricians. Yet, the unique information and knowledge doctor-parents have can be as much of a curse as a luxury. Usual defenses of intellectualisation and minimisation are no longer helpful, and doctor-parents report they are often surprised by the emotions they feel in a routine health scenario. Doctor-parents often have additional anxiety driven by the knowledge of the worst possible outcome. Some feel a need to “do something”, and are uncomfortable with both giving up medical control to a colleague and remaining within the parental role. Some doctor-parents feel guilt and a sense of failure at “allowing” their child to become ill. In addition, some are painfully uncomfortable with finding themselves on the other side of the white coat.

Doctor-parents also need to recognise that their child’s doctor may feel intimidated by the parents’ dual role. In these cases, it seems to be helpful to frankly discuss boundaries, acknowledge the skill set and role of colleagues, avoid jargon and “shop talk”, include children and partners in all discussions, and respect advice given. It is also helpful to acknowledge the value of medical skills, such as asking good questions, being an advocate, negotiating access to resources and services, having insight into early warning signs of problems, and being aware of potential sources of solutions.

There have been no large studies on the phenomenon of doctor-parents treating their partners or children. However, it is widely acknowledged that such behaviour occurs and that it can be linked to difficulties with boundaries in medical practice.

Few would argue with a doctor-parent’s right to treat his or her child’s superficial abrasion or fever. But ethical overtones shift if doctor-parents treat their own children for such problems as cosmetic, mental, reproductive or oncological health. Yet, paediatricians and staff of doctors’ wellness programs have seen cases of such complex boundary violations, some of which resulted in the involvement of children’s protective services.

Some Canadian regulatory bodies are drafting policy to discourage doctors from treating family members. Studies are also in progress to estimate occurrence rates, improve understanding of the issues involved, and promote healthy debate in the profession.