Presumptive vs. Shared Decision Making in Pediatric Care: Are there lessons to learn from How Docs discuss Vaccines? [npr.org]

Hi you all. 

 

I simply feel it is important to tell families: Children's Exposure to Adverse Experiences /Toxic Stress damages children's developing brains. 

 

What a family would like to do with the knowledge is their choice but certainly they have a right to know.  I gave this information to my mom a couple years back and she was  mad that no one ever gave her the information especially considering the poor outcomes her kids have experienced.  

 

Now I understand there are lots of times families are in situations where eliminating toxic stress may be almost impossible but then strategies to build resilience and decrease the toxic effects on the brain should be sought. I am the most "tip-toe" doctor in the world. I am not a stereotypic... this is the way it is done - do it my way or the highway.  I personally work with parents at great lengths... that is why I think I get good results.... but Knowledge is Power and parents have a RIGHT to know.  

Leslie:

 

I also heard this item on the radio, but had a slightly different reaction.  Working closely with families who have children with special needs, we strongly advocate for a family-centered care approach, in which the family's point of view is given significant weight in any discussions about a child's care and treatment.  Taken at face value, Dr. Opel's 'presumptive approach' seems to fly in the face of a family-centered approach.  However, what it also does is make us think more deeply about what either approach means in practice. Clearly, families need to recognize the expertise and knowledge of the medical profession; equally, health care professionals at the individual level need to recognize the expertise and knowlege of the family. When the potential sequellae of an individual decision may have an effect on the wider community, as in the case of getting standard vaccinations, the concept of 'family-centered care' maybe needs to be revisted, as a concept of 'community-centered care' ?.

I agree with Jane and from my point of view ACEs are no different than lead poisoning or any toxin to childhood brain development.  ACEs and exposure to toxic stress /overwhelming adversity damage the brain and result in long term consequences. This is a serious public health and medical issue that parents have the right to know about and physicians have the responsibility to educate about. If fact this is the most important public health issue of our time.  We now know the consequences and the high prevalence.  It is time to act!

 

 

Leslie: You bring up such an important question. There's a movement stirring that believes "every person has a right to this important information". As Dr. Nadine Burke Harris says, physicians know that lead paint causes brain damage, and inform their patients about it; why wouldn't they do the same with ACEs?

 

Thanks for posting this! 

This is good information Leslie. in peds we are encouraged to discuss immunization a and parents thoughts about them. I am wondering if there was a sex difference in the doctors who just assumed ... Could be more males than females. In the future I may try the just assume approach.

I have a huge problem as our whole area does with vaccine refusal.

For trauma  being factual about how trauma affects people and just telling how it is may be good. I'm not sure if a discussion the line of what do you think about the facts would be needed as we know that exposure to aces produces negative health outcomes for kids.

Certainly being compassionate to anyone who has experienced or is experiencing trauma I think is a necessary. I will have to think about this more.