Dori Durbin: [00:00:00] Hello, and welcome to That's Good Parenting, the podcast where we look for simple steps to reduce parenting stress. I'm your host, Dorrie Durbin, children's book illustrator, book coach, and of course, podcaster.

Dori Durbin: I help parenting experts take their biggest ideas and concise them into children's books so families can continue learning long after that conversation ends. There's one thing that I've learned through my work, that the hardest conversation for adults often is also very, very difficult to explain to kids, and healthcare certainly is one of those areas.

Dori Durbin: Every parent hopes they never have to make a decision medically for their child, but when those moments do come, our emotions as parents run high, and the information is overwhelming, so it becomes really difficult to make decisions that we can count on. Today's guest has spent her career helping families navigate those moments with greater confidence, clarity, and trust.

Dori Durbin: Dr. Emily Voss is a professor of otolaryngology, pediatrics, health [00:01:00] policy and management, and she's also the director of pediatrics otolaryngology at John Hopkins Medicine. Her work focuses not only on caring for children, but also helping parents and physicians communicate so that families can make confident healthcare decisions.

Dori Durbin: Emily, welcome to the show. 

Emily Boss: Oh, I'm so happy to be here. Thanks, Dorrie. And I'll tell you- Yeah ... my husband took, it took him a year to learn how to say otolaryngology, so 

Dori Durbin: I practiced, and I still was not sure I was doing it right, so thank you. I appreciate that. So one of my biggest questions with you from the very beginning is I am fascinated how you started in medicine as a doctor, and then have kind of shifted over to helping parents really make those healthcare decisions.

Dori Durbin: Can you tell us a little bit about where that shift happened and why? 

Emily Boss: Yeah, absolutely. I was an artsy kid. I did art and student government, and I really... When I got to college, I took the, my science requirements first and [00:02:00] second quarter. I did Rocks for Jocks, I think was the nickname. It was the Earth as a planet, and I did an astronomy course to just, uh, just knock it out, and so I could move on with education.

Emily Boss: And I, I'll tell you, I was... I think I lived... In, during college, I lived up near a lot of the, the science and pre-med students, and for... And so I was surrounded by people who were immersed in science. And I had this reflection one day, and my parents could talk about it too, just like I called them out of the blue.

Emily Boss: So when my younger sister when I was nine, my younger sister was four, and she had leukemia. And I don't remember so much about the experience, but I do remember my parents sitting me and my older sister down to tell me about our sister- who was sick. And I really started reflecting on this experience that my parents had, having a child with cancer, and navigating their community, and their friends, and their parents, and all of this interface with- With, um, with [00:03:00] the, the physicians and the nurses and, , and all of the people that participate in cancer care.

Emily Boss: And so I, I just sort of had this moment of if I start in the beginning and go through, I can be pre-med like all of these other people that I'm living around, and that's how I got into medicine. And, uh, you know, and that, that was sort of the first day of the rest of my life. So I started at Johns Hopkins.

Emily Boss: I initially did wanna be a pediatric oncologist, a cancer doctor. When I was in medical school, I loved surgery, and pediatric ENT or otolaryngology is this wonderful mix of both medicine and surgery, and I get to work with kids and patients and families. 

Dori Durbin: Wow, that's amazing. I love how you shifted. And to think that you were, like, artsy, you said, and to move into...

Dori Durbin: But th- it is kind of a natural progression, because surgery is an art in itself. 

Emily Boss: Th- that's... It really is. And speaking to people and relating to people and actually relating to our colleagues, I mean, all of that involves humanities. Uh, the [00:04:00] science is a lot of the building blocks, and there are, there are people who are really devoted to, medical innovation and, uh, and discovering- Mm-hmm

Emily Boss: new drug therapy. And so there, there's a place for everybody in medicine. I think w- you know, especially now with all of this evolving technology, AI, the worldwide web, you know, w- we, um, we are at more risk of trust in healthcare fraying from becoming dehumanized. So really keeping human beings in medicine and learning how to communicate is a central focus for me.

Dori Durbin: You know, it's funny that you mention that because I, I can even say that my own family has used AI to try to diagnose themselves. And, you know, when it comes down to it, there's so much information that it is, it's... as a parent, it's overwhelming. 

Dori Durbin: And you start to look up Zocdoc, you try to look up, you know, uh, reviews.

Dori Durbin: You look up, you know, um, when it was Medline, you could look up things. Um, just all of the different resources, and I think it causes almost like this paralysis- Right ... for families to make decisions. So how do [00:05:00] you help parents take the information and weed through it so that they can actually make decisions?

Emily Boss: Yeah. I would say, first, as a physician, if I have a symptom or my child has a symptom or my dog has, you know, the first thing I do is go to the internet and start, start, you know- Even with all of my medical and health resources, right? Like, there's something about the synthesis of information that you can receive and learning about other people's experiences firsthand that's really, really powerful.

Emily Boss: Um, but, you know, when we're in the, in a visit where we're trying to focus on what is the most important problem and g- give us, we sort of really dive into timeline and things that make the problem better or worse and, uh, different potential treatments that have already happened for the problem and h- the severity.

Emily Boss: Mm. That's, that's some of the key. And a lot of it also is really understanding what the biggest concern is for a parent. So, you know, s- somebody can come in and they can have a host of things going on, and it's not always clear [00:06:00] of like what are you the most worried about in this scenario, 

Dori Durbin: yeah. Yeah. Well, there, like you said, there's so many different elements, and probably depending on the situation, depending on the time of day, there's different things that are gonna pop up- ... that weren't there before. So let me ask you this. Are... My reaction as a parent is I don't want to ask the dumb questions.

Dori Durbin: I don't wanna ask the wrong questions. And then probably if I do that, I'm gonna go home and I'm gonna have so many unanswered questions, the anxiety is just going to well up. So how do I decide what kind of questions I should be asking? And I know it depends on what scenario we're dealing with as far as healthcare, um, but how do I start to sort that out as a parent myself?

Emily Boss: Yeah. I- what you just said makes me sad and because it's so true on so many levels, is that people are so afraid of saying the wrong thing or sounding s- silly or uninformed. Oh, a- and, uh, and that's a theme that we hear [00:07:00] from these, of mothers that we've interviewed over and over again, is just like I don't...

Emily Boss: You know, this person in front of me has so much knowledge, and I, I don't wanna say the wrong thing. I'll just tell you, w- one thing I didn't tell you about my, my intro or my career is over time I've, I've developed this lab. In our research lab, we actually audio record real time consults or conversations with u- it's u- usually parents, uh, for the, the care of a child that's in front of us.

Emily Boss: And, um, and then we can go back and analyze that communication. Then often we'll go and interview the parent after the visit and say like, "What resonated with you?" Or, "How, how did this make you feel?" Or, you know, "What, what was said?" So we did one study that looked at the use of jargon, so like complex language or terminology.

Emily Boss: Uh, if I say, "We need to take your child's adenoids out," at the end of the visit somebody might say, "Wait, what are... What? The what? Uh, what are the adenoids?" Right? And so like an ex- uh, something better would be for me to say, "We need to take the adenoids out. That's this, um, lymph tissue that sits in the back of the nose."

Emily Boss: That might not have [00:08:00] even been the best explanation, but it's just, you know, something to explain these terms. But what we found was that when parents introduced- jargon or complex terms, the physicians used it more. So, um, they would ma- match the parents' language and, um, that didn't result in more understanding.

Emily Boss: It was a lot of times, you know, there's this assumption that the parents might feel like they're supposed to say the terms or know the terms and have done the research. So, um, we just, I just wanna always meet somebody where they are in terms of their level of understanding so that we can really get to the bottom of what's going on.

Dori Durbin: So if I was a parent that did some of the AI research and I got some terminology off of 

Emily Boss: Yes ... 

Dori Durbin: and I used it, then the doctor's gonna think that I understand that whole system or the complexity of what that term re- represents. 

Emily Boss: They could. So I think- Yeah ... really make sure that you, if you, if there's a t- term or, you know, a, a theme that you do not understand, that you are ready to, to ask.

Emily Boss: I... People do walk in with lists of questions. I know that some people [00:09:00] bristle about, about when somebody has a list of questions, but I don't think that's the right thing to do. I actually love it. It helps me understand what somebody's really worried about, and I can say, "Hey, that's way out of left field" or, or, you know, "That's, that I'm not concerned at all about that issue in your child's scenario."

Emily Boss: So, um, so I think questions are power. And usually people do figure out the questions they really wanna ask. They're not asking, it's not like asking for an entire, um, you know, my entire CV and, and, um, and the entire, pathology of the, of the problem and the medical scenario. 

Dori Durbin: Yeah. Yeah. This, um... So when you talk about questions, I, it keeps running through my own mind of like, what are some questions that- Almost every parent should be asking.

Dori Durbin: Um, let's say for instance we have a surgery. You know, you talked about adenoids. There's a lot of concerns that would run through my head, you know, as far as anesthesia, recovery you know, what can they eat afterwards? What can they... What should we do before? What are some questions that should be in every [00:10:00] scenario as far as, like, let's say a child's surgery?

Emily Boss: Yeah. I would always tell parents to ask, "What are my options?" Or, "Are there other options?" 'Cause sometimes we assume that the... there's a, the, a treatment that they know about, or that the only thing that they're looking for is, is this s- common surgery that I, I might offer. So, um, asking, "What are my options?

Emily Boss: What should I be worrying about? Or what are the risks?" Often I would say surgeons, uh, or surgical clinicians are explaining risks. But, um, to your point, you know, we did a, a, a study where we interviewed moms, and, uh, and 10 out of 10 parents said that they were really afraid of anesthesia. You know how often anesthesia is actually even mentioned?

Emily Boss: We might say, "This is performed under general anesthesia," or, "Your child will be under anesthesia," but we don't go into the risks mostly because it's so, so safe. And, um, and, you know, I'm not even thinking about it particularly for otherwise healthy kids who are having elective surgery. But if you ask the parents what they're most afraid of, it's anesthesia.

Emily Boss: So if that really is your biggest fear, [00:11:00] ask a question about it, right? Say, "What should I be worried about? What are my options?" And then I always love this question, "What would you do if this were your child?" Or, or more simply, "What do you recommend?" It really does force a pause and force some reflection from the clinician that you are engaging with and talking to for them to say, "This is what I would do," and I want them to put a why behind it.

Emily Boss: And if they don't, you can follow that up with why, right? 'Cause... And I, and I might say, like, "I, in this scenario, I would do a tonsillectomy because your child's been snoring and, uh, gasping for over a year, and is having trouble paying attention in school." Right? Like, so I, I would say and you've expressed those concerns."

Emily Boss: , So, so that's my list for you of really good questions to come in with. And then, if there's anything else that you're concerned about that's related to the, the problem at hand, just have it ready. 

Dori Durbin: So really that time of asking questions, we shouldn't feel rushed. We should feel like we've got everything answered before we even leave the office.[00:12:00]

Dori Durbin: So what if we leave and we have another one? Is it annoying for us to call you back and ask more questions? 

Emily Boss: No, you're right. It... I mean, there is a balance. Like, you're talking about the true realities of healthcare. We have usually 10 minutes. I, I mean, I will probably- Yeah ... have 16 to 18 patients that are scheduled in a four-hour session, and that is because I have to, I have to do that.

Emily Boss: Um, that's, that's, so that's the way the, the world. And also in that time, I'm making sure that the documentation is correct and that I've coded the right thing, and that if I've provided you with information, I've given you the right information or resources. Hopefully, you're getting those written resources or links to videos that are reliable that will also give you more information, but there should be some follow-up mechanism.

Emily Boss: And the, the patient portal is really nice. We use MyChart a lot. MyChart is often answered by by staff. That can be nurses. That can, can be, um, o- other different clinical staff, and that's great 'cause that's more information. And if it really needs to go to the, the [00:13:00] physician or the, the practitioner that you saw, then it does. 

Dori Durbin: I guess that's something too, maybe that trail is good for when the surgery actually does come and the physician knows, "Okay, this parent was really worried about the anesthesia, and we need to reassure them when they come in-" Mm-hmm ... "that it's gonna be okay." You know, so maybe that is helpful for everybody.

Emily Boss: I mean, I'll tell you- Yeah ... after, after we wrote about that, I try now always to just follow up with this. And anesthesia is really, really safe for kids who are otherwise healthy. And actually, even for kids who are not, right? Like, the, the anesthesia isn't usually the, the concern that I have going in. 

Dori Durbin: Both of my kids have had major surgeries, and I remember that was, that was my biggest thing, and that and recovery. Because the recovery piece of it, I was like, "Okay, what don't we know going into this that's gonna happen afterwards that I need to be prepared for?" 

Emily Boss: Mm-hmm.

Dori Durbin: And I think that, that is, in my mind, second-highest thing is, you know, what happens next? I feel like so many times we think we ask the right questions, but [00:14:00] then we don't realize that there's more to it. Or afterwards, do I need to be worried about what's happening to my kid now? So is that a common thing that you found in your research as well?

Emily Boss: I think the recovery is probably the biggest concern, and a lot of times people will make choices based on what the recovery is going to be. Um, so there's- Mm-hmm ... that period. You know, for example, with removing tonsils and adenoids, a lot of times kids can be out for two weeks, and actually really out. It can really cause significant pain, and there's risk of having bleeding, and there are different things that we do for that and different methods of that type of surgery.

Emily Boss: But, that's a big deal. So somebody might come in saying, "You know, I'm worried about his sleep," but, uh, he's on a sports, a really competitive sports team and is in season from July to November, right? And so that, that actually helps with some, some amount of decision-making or guidance, like in terms of presenting options.

Emily Boss: S- and a lot of people will say, like, "I am most afraid of watching my child be in pain or giving my child medication. You know, my child won't [00:15:00] swallow any medication. How am I gonna treat their pain after this kind of surgery?" So I think that is really important. 

Dori Durbin: Are there a lot of, other things that you can do instead to help relieve some of the pain.

Emily Boss: Yeah. I mean, there are- Yeah ... a million things. What did I just recently read about? I don't necessarily advise this, but I think it's a cool concept. Mm-hmm. Like vibration or sound vibration or these little type of vibration devices that might po- potentially trick your brain. Um, I think I was having a procedure and somebody was using this, like, little beading thing on my forehead.

Emily Boss: So, um, so... And I thought that was pretty neat. I don't, I don't have all of the science around that, but in, in head and neck surgery, a lot of times we'll recommend cool cloths and popsicles and, uh, ice cream. That's, that's sort of standard, but, you know, different positioning that might make a child more comfortable.

Dori Durbin: Yeah. That makes sense. Um, the surgeries my kids have had have all been, like, leg, hip kind of things, so we've used the ice machine instead of doing, uh, you know, as much Tylenol. and, again, you can talk to your physician about and ask [00:16:00] questions, right?

Emily Boss: That's right I was gonna mention another story you reminded me of. I always learn a lot from parents themselves, and I remember asking somebody in the clinic, they, their child had already had surgery and we were months out, and I just said, like, "What what didn't we tell you?" Or, you know, "How, how did it go for you on that day?"

Emily Boss: Like, "What, what should I have told you that I didn't?" And the mother said, "I wasn't prepared for that recovery unit." Like, the child was so... And this is true. Watching kids wake up, some kids wake up like- Um, like I wish I had a video of them 'cause they're so perfectly you know? They're so- they, they look so perfect, but some really wake up fighting and crying, and it's so sad to see your child disoriented and, and groggy and having some pain.

Emily Boss: And so, um, so having that, that knowledge of I wasn't prepared for the PACU, let's, the post-anesthesia care unit, and like watching my kid wake up. Now I try to tell parents as I'm bringing them back to the, the recovery unit, "Just so you know, this might be the worst part, right? Like, they're not gonna remember this, but, [00:17:00] um, that this..."

Emily Boss: Some, some parents will say this is the worst 

Dori Durbin: I, I did have that experience with one of my kids where she woke up just screaming, and they brought me back to the room, and I could hear a kid crying, and I didn't even recognize her.

Dori Durbin: And I thought for sure, like, you go through that moment as a parent thinking that you broke your kid. I just broke my child

Emily Boss: and, um- It, it is totally true. It, and, and also, you know, we might be ha- there might be 25 kids at the, at a surgery center in a day. And so like you said, the, the parents are hearing other parents, other children cry or, you know, even sometimes have a problem, and they'll, they'll then watch people respond, and that, that can be really frightening.

Emily Boss: Uh, a, I just interacted recently with a mother, and I've had versions of this interaction a million times, but she was so worried about having made the wrong decision for her child. We talked, and I had met her on the day of surgery because she had been seen by our a nurse practitioner in our practice.

Emily Boss: That's, that's, pretty common. So we were talking, and, she said to me before surgery, "I almost canceled this, but I heard the breathing problem again, [00:18:00] so we're gonna go for it." And, and, um, and so, I talked to her. We're in recovery room, right? The, the surgery's done. The child did great.

Emily Boss: He's waking up and, and, and getting ready to go. And I said, "Oh, gosh, I'm so glad we did this. He really needed that, that surgery. There was so much stuff in there, so much tissue." And she looked at me, she paused, and she said, "You just gave me a present." Like, her release at that moment of just being so reassured that she had done the right thing was, was so incredibly poignant

Dori Durbin: oh, you probably really did- Mm ... I think that's the fear is that not only did you decide something for your child that they have to live with, but you might have made the wrong decision. But honestly, if you're at that point, that's where that trust in the doctor telling you the truth

Dori Durbin: I think sometimes, and I hate saying this, but I think sometimes parents come into it thinking that there's ulterior motives. Like, they don't really need the surgery yet. And I think, you can agree I think that most doctors are not in it for the money.

Dori Durbin: They're in it for the patients. Mm-hmm. And they [00:19:00] want the patient to feel better, and that's why you're coming to them. 

Emily Boss: That's right. That, that is really true. And I will say, like, there are some cases that are slam dunks. Like, I know- Mm ... your child needed this. I know your child is gonna do better w- when everything is said and done and we're all healed.

Emily Boss: There are some that it's not as much of a direct hit, but I, but we always go in with a joint understanding of I think this could help. There's a chance it doesn't help as much as we want it to. You know, like for example, if somebody's having problems with behavior, Like, problems with sleep can actually sometimes be, be masked with symptoms of attention deficit or, uh, hyperactivity.

Emily Boss: So they might be saying, "My child's having problems with behavior and is snoring." So we, I can say I'm, I'm pretty sure we can help snoring, but th- whether or not that it directly affects behavior that's a little looser. So we j- just as long as everybody's going in with all with all eyes open and, and we've made that agreement in advance.

Emily Boss: There are families that are like, "This is a real problem. We wanna do [00:20:00] anything we can to knock it out." And, um, and sometimes, you know, they will know that surgery's one option and isn't necessarily the end-all solution. And I just think the most important thing is having transparency about that in advance and everyone being on board.

Dori Durbin: That's awesome. Well, and that, one thing I, I kinda wanted to ask you was I feel like maybe you're in a spot where you're kind of, navigating between parents and physicians. So is there ever a time when you wish that physicians understood something about parents and parents understood something about physicians?

Emily Boss: Oh, yes. That, that has happened a lot of times. Like, we, we sort of talked about this earlier, when you said, you said- Mm-hmm ... "So how many questions can I ask?" Which I think, first of all, 99 out of 100 patients or families are always so respectful of time and understanding. But every so often, we, we don't have that moment, right?

Emily Boss: And so, like, there's a, there's, um, there's a stretch beyond, um, beyond what I would be capable of giving or providing. Like, every so often, [00:21:00] somebody'll have, their, child has an appointment, and they'll bring in another kid saying like, "Oh can you, can... I have a question about this one, too." And I love that 'cause I, I do really wanna help, but we're also bound to all these different, patient privacy, um, issues and documentation.

Emily Boss: Like, so there's some ethics behind that. And so, you know, it gives you this, this, this funny it puts you in this sort of funny position. I would say, like, I think I have gained so much more recognition over the years, you know, I've been practicing now for two decades, about parents th- they might be having quite a day.

Emily Boss: I remember I saw I had this m- mother of a child, this is a child actually she had adopted. He has a lot of complex medical issues, and, and she has a new baby, and they have other children and- Mm-hmm ... sh- I was seeing him for a routine appointment. She goes, "Oh, Dr. Voss, I wanted to apologize for missing our appointment last month."

Emily Boss: Which of course I didn't even, I probably didn't even know. I didn't re- I certainly didn't remember. But she's sitting here apologizing to me about missing this appointment when, there's just so much [00:22:00] complexity with this patient and th- their siblings and just life and taking time off of work and, and so I I, you know, I wish that a- all physicians or clinicians, could have those moments of empathy.

Emily Boss: I will tell you I try to have them, and I'm sure I'm, I miss the, the mark probably done that on many occasions. And, and so that's where, like, always just being an advocate for yourself and your child to say, "Wait, wait. I know you just said this, but I just want to tell you what, what I'm really thinking about here, and make sure you would, you know, like, that, that you heard me."

Emily Boss: I, I'll give you another story, actually. I remember it was another family that I was meeting on the day of surgery, and we were doing something, um, less invasive. It was a ear tube procedure, which is still under anesthesia. It is still surgery, and it, and parents are still scared. But, it's true, I, I probably had 15 patients on schedule that day.

Marker

Emily Boss: I was doing a bunch of things and- Mm-hmm ... and, um, and she said, "Hey, Dr. Voss, I know you do this so many thousands of times a, a year, and you're doing this a million times today, but for just these few [00:23:00] moments that you're with my child, I really want you to be thinking about my child." I will never forget that.

Emily Boss: It was such a wonderful reminder of be- being present and being present for the person that you're taking care of and- Mm-hmm ... uh, sort of drowning out the noise that, uh, that's really stuck with me throughout my practice. 

Dori Durbin: Oh, I think I would've cried. That is so precious. And the fact that you were sensitive to that too, just it...

Dori Durbin: Yeah. That's amazing. Mm-hmm. I appreciate you sharing that. I know when we go to doctor's appointments as parents we're worried. We're, you know, showing the physicians that we're worried. We're showing everybody in the office we're worried. How does that affect our kids?

Dori Durbin: Yeah. And I, I mean that in the, the most, like, logical sense, but also an emotional sense because they know us so well, and they're assessing the situation. So, do you have any advice for the parents from that perspective?

Emily Boss: This is just so true. Like, uh, you know, we... And this is true for all of parenting, right?

Emily Boss: I'm sure you've experienced this. Like, you know, like, [00:24:00] they will feel what we are feeling, and they're more affected by our anxiety and our worries more than, um, more than, than we even know. I mean, I, I can think of a million times where I've reacted too quickly in front of my child that I, I, you know, I know that's that she feels that.

Emily Boss: I'll, I'll say he- if there's a, a child who's a, who speaks and can express thoughts, like, like anyone in school age, having the, talking to them in advance and having them write out some questions is really helpful. I'll just use tonsillectomy again as an example just 'cause it's such a common pediatric ENT surgery that we do.

Emily Boss: But if the parents will come in saying like, "What are the risks of anesthesia," and, "Does my child need this surgery?" And, you know, "W- what do we need to do a- afterwards in terms of pain medication?" And, "What's the risk of bleeding?" Or, you know, something to that effect. And the child, if they've written down the question, and they'll be like, "Can I eat rice after surgery?"

Emily Boss: "Will I lose my voice after surgery? Can I sing after surgery?" Right? Like, the questions are really different, so trying [00:25:00] to understand if the kid has worries, what the kid's worries are that's a big deal. And the older the child is, they will remember something about the experience 

Dori Durbin: I l- I love that, the fact that there's such a big discrepancy between what parents are worried about and what the kids are worried about.

Dori Durbin: Yeah. 'Cause, I mean, actually, it makes a lot of sense. And I, I love the fact that they were worried about doing the things that they loved- 

... 

Dori Durbin: More than, than the pain or anything else. That's right. So that's, that's a great suggestion. I love that. 

Emily Boss: Mm-hmm. 

Dori Durbin: As a children's book illustrator, Emily, one of my favorite parts of illustrating kids' books and the coaching people is figuring out how to make really complex things much more simple for kids.

Dori Durbin: So if I have a kid who's coming into a situation that they really need to understand, um, what is one thing that you would really want them to understand about their healthcare and really be able to own that knowledge? 

Emily Boss: That's a great question. I will t- always tell kids that [00:26:00] express some kind of fear, "You got all these people here taking care of you."

Emily Boss: Now, I don't actually know what results in the child having relief, but, you know, sometimes I'll say, like, "Look at all these moms and dads that are taking care of you," or, you know, "All of these people are here to take care of you, and we're, we're all feeling really good." And, um, and so, like, really just expressing the intent of, of people that are focusing on the child and, and, and how we just really wanna make you feel better.

Emily Boss: We really wanna make it so that you can love school, and do better at school, or so you can sleep at night. I think that's, the intention behind the care. 

Dori Durbin: Yeah. Do you think having them understand,, what's gonna happen next... I mean, when my kids were little, I'll go back to this, but we actually took stuffed animals in, and they prepped the stuffed animals while they were working on the kids.

Dori Durbin: So the same thing happened. They talked through. "What's gonna happen when you wake up. They're gonna be a little sore. What's gonna happen next? What's gonna happen next?" Does that prepare the kids even more than just kind of going into it, or is that too [00:27:00] much? 

Emily Boss: Well, first I'll tell you that the angels of the hospital are child life specialists, and, um, and we, at least in, in my surgical practice at our - main hospital where we do usually more more tertiary or you know, more critical cases or patients who have more baseline illness, we do have child life.

Emily Boss: And they're so, they're amazing, 'cause they do just that. They'll come in with animals, and they'll have masks. And, you know, a lot of times we'll, we'll use a, a mask on the child to help them fall asleep before- starting an IV. And they're allowed to pick a flavor of, you, you remember that Bonbel or one of those Chapsticks that, um, that has a flavor?

Emily Boss: And so they go through the flavors, and they can pick a flavor. So sometimes they're able to pick a flavor for their, their stuffy or their stuffed animals. And, and a lot of times the surgery center or the, the unit will have some kind of, of gift for the child, like, to say that you've been here. It's so child-dependent, and, and parents usually know their kid more about is too mu- is [00:28:00] too much information gonna, tip us over the edge?

Emily Boss: And, that can be a factor. You know, I was thinking about something you said about parent worry. This is always an issue in pediatric surgical care, should the parents come back to the room as the child's going to sleep under anesthesia? And I will tell you that, talk about, like, most of the time, when that's happening it's more for the parent.

Emily Boss: You know, we like, sometimes the parent is so upset and so worried that the child will really feed off of it. It's very case-dependent, but, you know, there's, there's both sides of the coin there. 

Dori Durbin: So do you have to analyze the parent real quick and make that decision? 

Emily Boss: You know, they, I, the, the anesthesiologists usually have, they have protocols and if there are different special circumstances, then they'll usually work with the patient and family.

Emily Boss: But, um, you know, we've had- we've had parents getting real, real clammy and passing you know, near passing out, and that, that's a different, that's a different scenario 

Dori Durbin: The child life care specialist, does every hospital have those, or is it mainly more critical [00:29:00] situations? 

Emily Boss: I think a lot of children's hospitals or, or hospitals that focus on children's care do have child life.

Emily Boss: It's very location dependent. It's a quality of care resource, right? So they don't so you always have to lobby for that resource from your, your executive teams and your administrators to say, "This is so important for the welfare of children and for our operation, you know, to provide a family-centered care experience."

Emily Boss: That's awesome. But they're just truly wonderful people, who have amazing training 

Dori Durbin: That's awesome. If I knew that I could,, find a hospital that had them, I would totally do that. But it sounds like we had kind of a similar experience.

Emily Boss: And, you know, the other thing is, is, like, i- if we all had every resource available, there's so many things we could do.

Emily Boss: But a lot of times that's not the case, you know? And you make decisions based on your location and your insurance and the, and timing and, you know, and who you were referred to. And, and so, like, a lot of times, um, you don't have the luxury of going and seeing multiple different specialists for the [00:30:00] same problem.

Emily Boss: And and I guess that still goes back to this idea that most people on the other side of the table, like me and other clinicians, are really just try- trying to do the right thing for you and for your children. 

Dori Durbin: So what if you did get in a situation where you weren't as comfortable? Maybe the communication wasn't real solid and clear.

Dori Durbin: Maybe You had, like, a general unease about the, the conversation. Would you recommend just seeing it through? Would you recommend looking for other people? Like, how do you know when you need to shift over? 

Emily Boss: I think if you really believe that you should shift, if you felt dismissed, if you did not feel heard, if anything made you uncomfortable, it is always worth another opinion.

Emily Boss: And most people are not offended, by the way, by, uh- second opinions. And if they are, that, that should be a big red flag. Um, you know, sometimes I'll see patients, like, it might be the fourth opinion, and it's a, it's for a problem that is very complex to the family and l- and less, and more [00:31:00] straightforward to me, and that, that may be a parent that is really seeking the answer that they wanna hear or seeking, like, an answer that, that aligns with their values, right?

Emily Boss: Um, so I will try to, to balance, um, second opinions and third and fourth opinions just to understand what's the motive. Like, why did you come here? And now, again, now that I'm old and have been practicing for a long time, I actually just point-blank ask everyone, like what happened here that didn't happen before?"

Emily Boss: Or, "What happened before that made you wanna get another, another look?" 

Dori Durbin: Yeah. That's really great advice. And that's interesting too because I have heard of that too where it just- There's never a kind of a comfortable fit, so what is it that they're really looking for? 

Dori Durbin: That's really great.

Dori Durbin: Yeah. 

Emily Boss: That happened... I mean, for me, I had a, a hamstring injury, which was really terribly painful. And the- fix for it, if you had surgery, it's a really big surgery. It's like a bigger deal than a hip replacement in some regards, and there aren't a lot of hamstring surgeons. It's a little bit more niche.

Emily Boss: But I did see a [00:32:00] whole lot of surgeons, and Somebody asked me, like, why'd you see so many people?" And I realized that I really wanted them to tell me what I wanted to hear, you know? I kinda knew that some peop- there are locations, which I wasn't in, that people who have the surgery are swimming a week later, and I was seeing people who were saying you need to be immobile for six weeks.

Emily Boss: And I really wanted to hear the answer that I, I wanted to hear and, um, or at least transparency around w- why that wasn't the case or why that wasn't the recommendation. 

Dori Durbin: Yeah. I don't blame you. I would've wanted to swim, too. 

Emily Boss: Yeah. 

Dori Durbin: Well, let me ask you this. I know that families forget medical details over time, like whether it went great or bad, but they rarely forget how they were actually treated.

Dori Durbin: So when parents leave an office, what do you hope that they carry home besides a treatment plan? 

Emily Boss: That's a great question. I think confidence in their decision or confidence at least in their team. So I really want them to feel like they walked out at least with some [00:33:00] answers and, uh, are not terribly conflicted over next steps.

Emily Boss: Or if they are still conflicted over what the, what their decision should be, at least they're empowered in some way on how to get more information. We look a lot at these concepts of, three things. One is called predisposition. It's like a patient comes into your office, and they already know what they want, right?

Emily Boss: Like, they already know the child is snoring and has big tonsils, and they're just ready to sign up and get this over with. So that's like how mu- how likely were they to choose treatment based on, without h- ever having even seen me. And then there's this idea, again, of,, con- decision conflict.

Emily Boss: How after the visits happen, you know, how much are they conflicted over what to do now that they've heard all this information, had this communication? And then later on it's like, "Do I regret what I did? Do I regret having waited? Do I regret doing this surgery?" You know? It, y- and the more effective communication definitely results in parents being less [00:34:00] conflicted and having less regret later about their decisions.

Dori Durbin: I love it. I love the fact that, that communication is really the real key to all of this. . Like, it's just getting it out there, understanding what the perspectives are, understanding the terminologies, just laying it all out, pretending to, to not know anything if you need to just to get the information solidly.

Emily Boss: That's right. 

Dori Durbin: Yeah. Emily, you have shared so many great things. I think we could probably talk for another hour, honestly. But one thing I wanted to provide for parents is a way for them to contact you or find out more information about your research and what you're doing. So where are the best places to find you?

Emily Boss: Please come and find me. I have a, a website that I just launched. It's, dremilyboss.com, which is exciting, and I talk a lot about the research that I have done, my, my team that does this research with me. And I also talk about some of my writing and speaking. I really wanna work with organizations an- that, that represent patients and parents and families, and also organizations [00:35:00] that are building, healthcare.

Emily Boss: I wanna keep people in the center of healthcare. So anything that we can do to allow parents to focus on receiving care and clinicians to focus on providing care, and take out the rest of the noise that's where I'm, I'm really passionate. 

Dori Durbin: I love it. Okay. You're really great at giving us simple steps, so I'm gonna ask you a very last question.

Dori Durbin: We always have one action step to the end. So if parents know that their child is having a healthcare issue or they're seeking questions from a doctor, what is one simple thing that they can do to make their stress less and make their communication more clear? 

Emily Boss: Think in advance about what is the thing they are most worried about and what matters most to them.

Emily Boss: So are they . Using my sleep example, are they most worried about how their child is sleeping at night? Are they most worried about how the child is functioning during the day and interacting at school? Are they most worried about taking time off of work, [00:36:00] or their child missing sports or school or life activities, or taking medication?

Emily Boss: So being able to really communicate that is so helpful. And then also, the, "What are my options?" Knowing to ask that in advance, and also knowing that sometimes doing nothing is a treatment, right? Like, as we call it, watchful waiting. It's like observation and time often really are a solution.

Emily Boss: And, um, so just remember that's an option too. 

Dori Durbin: Oh my gosh, I love that. I love the fact that you don't have to make a decision. You can just watch and see what's going on too that's great advice. Oh, Dr. Emily, thank you so much for joining us today. I appreciate what you're doing for everyone, for the patients, the parents, and the physicians.

Dori Durbin: I think it's amazing, and I just love how you're helping families now, but also how you'll be helping them even more in the future. 

Emily Boss: Oh, thank you so much for having me, Dora. It's been a wonderful conversation. 

Dori Durbin: Oh, I've loved it. And thank you to everyone who's listening. If today's conversation encouraged you or helped you feel a little bit more [00:37:00] prepared for your next doctor's visit, I would love for you to share this episode with another parent or five who could use this encouragement.

Dori Durbin: And if we want to continue conversations like this with parents who wanna reduce stress, I would love for you also to be a part of That's Good Parenting Club. It's a community where experts like Emily can shape books into resources and have those conversations continue long after this episode ends. So until next time, let's take some small, logical steps that make big connections and allow you to say at the end of the day, "Now that, that was good parenting."

Dori Durbin: See you soon.