To Fear or Not to Fear

A few days back, at a health clinic I work at, I observed the staff of the clinic trying to convince a 3-year-old boy to allow them to measure his height using a measuring tape attached to a wall. A staff member demonstrated how the boy had to stand erect against a wall, after which the tape would be pulled down to his head, the height noted and then the tape would be released back. When the tape was released above the staff member’s head there was a considerable recoil, which was noted by the child and he became reluctant to get his height measured. The more his mother tried to nudge him towards the wall, the greater he tried to edge away from it. Finally, upset with his parents he burst out with a loud cry, “I don’t want to do it, I am scared. “His outburst made the entire room, including me pause, midway. It’s been more than a few days since I observed this incident, yet my ears are still ringing with the boy’s cry.  Why so? 

The child’s frank admission of fear startled the staff of the clinic, his parents as well as me.  In this fast-paced, driven, ambitious, unforgiving world we live in, we are unused to listening to such an honest, innocent admission of fear. Just step back and see, if you can remember when the last time was that you admitted to anyone that you were scared to do something. Forget another person, what about yourself? Have you ever told yourself, I am scared! I know, I haven’t for quite some time. But the instances when I felt fear, are innumerable. Like doctors, I think we experience fear every day, whether it is just before a complicated procedure we are undertaking or when we are suggesting a treatment plan for a, particularly fussy patient. There is an element of uncertainty in every decision we make in our line of work that often haunts us. 

Do we as doctors, acknowledge this sense of fear and uncertainty we feel at times? I guess most of us would say no! For we feel that acknowledging any fear or uncertainty is a luxury we cannot afford. We want our patients to think of us as infallible and feel that showing even a hint of vulnerability in front of them could weaken their trust in us. While interacting with our senior colleagues, we worry that any admission of fear would be mistaken for us lacking capability and confidence and hence, here too, we refrain from expressing fear. And as for expressing fear to our own selves, we are so caught up in our daily schedule that we really have no time left to examine our own feelings. Is suppressing fear, healthy? Does ignoring fear or pushing it to the back of our mental closets really help us in the long run?

No, definitely, not! While ignoring or suppressing it may help us get on with our work, in the long run, it will take a toll on our mental as well as physical health. I think each one of us should have one person, maybe a friend or maybe a colleague or a senior in whom we can freely confide.  By ourselves too, we need to take out time each day to acknowledge the instances we felt fear throughout the day and accept mentally that it is a perfectly normal phenomenon and give ourselves credit for working our way through the fear.

Like that little boy who was afraid to get his height measured, in our practices, we encounter scores of little children who are scared or apprehensive of undergoing diagnostic tests or treatment procedures as they feel it would be painful for them. For a pediatric specialist of any healthcare field, this is an everyday phenomenon. At such times, while it may be our duty to guide them through their fear by using various behavioural techniques, it should not be at the cost of their freedom of expression. Let us teach our pediatric patients to overcome their fears by first allowing them to acknowledge its presence. At times, as doctors, we often notice children in our clinics who are visibly apprehensive of us.

The parents accompanying them are also aware of the child’s apprehension but tend to brush it aside. They expect that their child should be able to cope with his fears, no matter what. If the child can’t cope, they often express their disappointment to the child. The child may start considering his inability to cope as a failure and such experiences may be damaging to the child in the long run.

Rather than learning how to cope, the child might become even more fearful! We as doctors should guide parents to accept and acknowledge the child’s fear and not to ignore it.  There are also times when parents unknowingly use the child’s fear of doctors or injections to get them to do tasks they tend to avoid such as eating healthy food, brushing teeth etc. Parents should refrain from the same as children tend to absorb all information provided to them and a threat from the past may make them reluctant to approach doctors when they actually need treatments. 

Ultimately as healthcare providers, we sometimes may be successful in helping the child undergo treatments without pain, fear and apprehension. And there may be times when we may fail. Let us learn to accept failure as a possible outcome too. Let’s not consider it our personal failure or the child’s failure. When non-pharmacological behavioural techniques do not work, we can recourse to pharmacological behaviour management techniques. 

Whichever route we go down, let’s learn to our own behaviours and fears and our patient’s fears too!!!