Several of the steps that allow you to successfully reassure the caller are the same as those you need to make a good assessment. I like to speak to the child himself, if he is old enough. Not only is this good medicine and reassuring to you when he says happily that he is just watching a little TV, but it also reassures the parent that you really care about what’s going on and are collecting all the relevant data.
Collecting more data is an important way to calm down an anxious parent, allow her to gather her thoughts, and also let her know that you’re taking her seriously. Her anxiety extends from fear of illness to fear that she won’t be able to get the care she thinks her child needs. Asking the parent to push around on the belly of the crying baby, time respirations, take the temperature, send a photo of the rash, or try a dose of ibuprofen and then call you back engages the parent in action that itself reduces anxiety.
As a last resort, you might ask to speak with someone (less anxious) who was there earlier when the symptoms began or who just isn’t so upset.
So, I know what you’re thinking at 3 a.m. – or at least I know what I’m thinking. How can I get off the phone as quickly as possible?
As an experienced clinician, you may know in the first second, hearing that barking cough in the background, what the problem is. But giving advice at that point often backfires because the parent thinks you are brushing him off.
Believe it or not, one of the best, most efficient ways to reassure an anxious parent is to take an exhaustive history of the illness, moment by moment. This is important because it reassures the parent that you’re taking his concerns seriously. Otherwise, he feels compelled to repeat and rephrase or raise other concerns until he is convinced that you understand. This technique has actually been measured to take only 2 minutes or so and to be faster than responding to individual questions.
After you’ve heard the story, it’s best to provide "echoing" or active listening, reflecting back the key items of content, but also to gauge the parent’s emotions. "When he coughs so hard that he vomits, it can make you worry that he might stop breathing" might be an example of wording. This does not plant new fears (he already owns all of the worst ones), but instead, if you have guessed wrong about the extent of his concern, he will reassure you!
Asking what she’s afraid might happen and also what other people are saying about the symptoms or have told her to do, can be the key to a satisfied caller. Often, there’s a grandparent in the background who is spreading worry around, suggesting folk remedies or criticizing the parent, and the call is really for a second opinion or back up for the decision the parent has already made.
The next step is to go over your differential diagnosis so that she knows that you thought about the bad stuff that’s in the back of her mind, be it appendicitis or Lyme disease. Explain your reasoning for the course of action you propose she take between now and the morning. Be sure to make a plan that includes what she should be looking for to determine whether things are getting better or worse. Reviewing the details of what she should do, even coaching her to write it down, is also a way to keep her from calling you back 45 minutes later when you finally fall back to sleep!
Finally, there sits Pandora’s Box. It’s very important to ask, "Is there anything else you are worried about right now?" when anxiety seems to be out of proportion to the symptoms she is describing. Unexplainable anxiety sometimes indicates domestic violence, suicidal ideation, or child abuse about-to-happen that could be prevented. A call about a child’s symptoms is the only way some people know to cry for help.
Always offer anxious parents the option of going to the emergency department. Some families may be afraid that you’re blocking their access or won’t approve an ED visit to their insurance. As long as they are worried about that, they will hype up their complaints to make sure that they have that opportunity.
But what to do about the fact that it is 3:15 a.m. and now you are angry? Anger not only interferes with your judgment, but is likely to keep you awake for the rest of the night. It helps me to remember that people call because they’re either scared or lacking information about child health or both.