Tech + Health

02.14.14

Pediatrician: Don’t Make Your Kid’s Healthcare a Proxy in Your Divorce Battles

Most divorces are amicable. But sometimes they can get dirty—and its the kids who suffer most.

Some divorces are amicable.

For whatever reason, the relationship ends. But the former couple manage to maintain some level of good will toward each other. Perhaps they even remain on friendly terms.

I have many patients with parents like this. Though their marriage has come to an end, they find a way of treating each other well. Or at least they put aside their differences in the interest of their children, and commit to being cordial in their roles as co-parents. They both show up for medical appointments, they take each other’s perspectives seriously, and they come to decisions about their children’s care together.

I have tremendous respect for parents like these.

It must be at least a little bit difficult for some of them to rise above the troubles of their shared past. I try to make a point of acknowledging their shared presence in my office.  Nothing ostentatious, just a quick comment—“I’m glad you both could make it today.”  It demonstrates a willingness to prioritize their kids.

I wish all divorced parents behaved in this manner. Sadly, some don’t.

Some divorces are an exercise in bitterness and acrimony. Sometimes the ill will persists long after the relationship itself has come to an end. Sometimes the lingering hatred seems to become a defining characteristic for one or both of the former spouses.

And sometimes this carries over into their care of their children.

The overwhelming majority of divorced parents whose children I see are at least on civil terms. However, there are some who appear incapable of letting the slightest decision go unchallenged. Who make their children proxies in their ongoing war with each other.

And they try to make me one, too.

Often times, this doesn’t really involve me as a physician per se. Though I am involved in their children’s lives as a pediatrician, really I’m just a sounding board for their grievances.  The thinnest excuse is all that is needed to launch a diatribe about the other’s failures and flaws during an appointment. Or they won’t even bother with an excuse and will, triggered by some stimulus unknown to me, send me an email going on at length about what an awful person and parent their ex is.

“I once had a father strenuously object to his child using an inhaler for his asthma because it was his ex-wife who’d brought the child in for the problem.”

This gets as close to no response from me as possible.

If it’s during a visit, I try to steer the conversation toward ways they can find common ground with their former husbands or wives. Sadly, this is very rarely met with any kind of openness, and I’m left to change the subject entirely. My response to poisonous emails is a terse “thank you for contacting me” and nothing more.

A variation on this is the attempt to enlist me on their side in some skirmish or another.  One parent wants the other to do something, but can’t force the issue. And so they try to arrogate my medical authority for their cause. The connection to actual medical care is often tenuous at best, but that doesn’t seem to matter. “My child wants to take dance lessons, but my ex won’t drive her there on his days,” or some such. “Tell him you think dance lessons are important.”

I refuse to play this game.

I may it clear that I have no authority to wade into conflicts between parents, and my role is not that of mediator. Barring flagrantly inappropriate behavior or outright neglect or abuse, I cannot and will not take sides in this kind of conflict. Since requests of this kind also often come in e-mail form, they get always get a reply in which I describe my role as their child’s caregiver and advocate, not a go-between for parents who can’t get along. And I leave it to them to work it out.

The most professionally frustrating and extreme manifestation of these conflicts I encounter are the parents who choose to negate medical plans I have made, simply because they were made with the other parent. Much like politicians who will favor a given policy until the opposite side proposes it, the mere fact that the ex agreed to it renders it unpalatable.  There seems to be no medical decision too straightforward to disagree with. I once had a father strenuously object to his child using an inhaler for his asthma because it was his ex-wife who’d brought the child in for the problem.

Needless to say, there is no room for this kind of nonsense when it comes to actual medical care. I am not a diplomatic functionary and the child’s healthcare is not a treaty negotiation. Even if I had the desire to play that part (which, rest assured, I do not), I do not have the capacity to go between divorced parents and seek their mutual blessing on every medication or test or consultation, hammering out the details where there is disagreements.

When a parent contacts me with an objection to a plan I put into place for a medical issue, I inform them that both parents are always welcome at all appointments, and I’d be happy to entertain all questions that either might raise at that time.  But if they cannot work that arrangement out, then it should be understood that I make the plan with the parent who brings the child in. Barring a clinically relevant detail that was omitted during the visit, I’m not going to second-guess the plan just because the other parent wants to exercise his or her prerogatives.

As unpleasant as this kind of experience may be for me, it’s not really my problem.  I have the power to turn off the tap when the vitriol starts flowing, to shut down the conversation when it turns toxic.  I can draw lines around my responsibilities, and refuse to be drawn into the battles as former husband and wife try to lacerate each other.

The children involved have no such option.

They cannot extricate themselves from their parents’ mutual war. They are forced to endure while their parents model for them the very worst ways of dealing with conflict. They, who like all children need as many loving adults in their lives as possible, are instead made spies and pawns. Their welfare is made subordinate to their parents’ primary concern, which is destroying each other.

This is a tragedy, and one I am all too powerless to mitigate. Just like I cannot force one parent to do the bidding of the other, I cannot force them both to put aside their resentments and swallow their anger for their children’s sake. I can encourage them and counsel it, but I cannot demand it.

All I can do is be the most accessible doctor for their kids that I can be. I find opportunities to ask if they’re OK, and try to get them supports to deal with whatever emotional difficulties they may end up struggling with over time.

Nothing else remains for me but to wish it were different for them.