You do your best to shield your kids from the negative impact of divorce as much as possible. But what about the impact your divorce has on the people you trust to provide their medical care?
To find out how divorce impacts your children’s doctor’s ability to do their very important job - we spoke to top-notch pediatrician, Allison Koenig, M.D. Dr. Koenig is a graduate of Harvard University and The John Hopkins University School of Medicine, and has been in private practice at Piedmont Pediatrics in Atlanta, Georgia since 2002.
She shared with us the (surprising) ways divorce impacts her practice and what moms like you need to know - and do - to help pediatricians stay focused on caring for your kids’ health.
Q. You’re an expert in children’s health. How much of an impact does divorce have on their medical needs?
A. It can be really impactful on a child. Of course, to what degree depends on the child’s age and a whole lot of other factors. It doesn’t just start when parents decide to get a divorce. If there’s a lot of fighting at home, then children may show signs that they’re being affected well before their parents separate.
Tip for Mom: Whenever family dynamics are changing, pay special attention to any emotional or physical changes in your child - like mood changes or decreased appetite - as well as withdrawing from friends or a drop in school performance. Anything out of the ordinary is a good thing to report to your physician.
Q. And what about your practice itself - is it impacted a lot by divorce?
A. Definitely! It requires more time and resources to communicate things twice. One parent will bring the child to an appointment, but the parent who didn’t attend will expect us to call them after every appointment to discuss what happened. It also affects billing. Whichever parent brings the child in for an appointment is technically responsible for paying that day. But sometimes that parent isn’t legally (according to their court document) responsible for the bill, and doesn’t want to front the cost. We end up with large unpaid bills that our billing department has to spend time contacting parents about to figure out who’s responsible for paying.
Tip for Mom: While they want to keep you informed, understand it’s not your physician’s job to call a because they didn’t come to their child’s appointment. It is up to the parents to communicate with each other what transpired. Also, plan ahead for the fact that the parent who brings the child to the appointment will need to pay at that time.
Q. What do you see divorced parents argue about most?
A. When it comes to their kid’s care, the biggest disputes are usually over mental health issues. For example, a lot of parents argue about whether to medicate a child for ADHD. I’d like consensus from the parents, because it’s best for the child if they can agree.
We also see parents argue that they’re not being kept in the loop or are being shut out of medical decisions by the other parent.
Parents also seem to be doing things to try to create a record for their case. Before one parent might have been the one to bring the child to the appointments every time, but then they separate and all of a sudden both parents are there clamoring over each other to speak. We’ve even had parents videotape each other in our waiting room and record their child’s entire appointment on their cell phones! That’s distracting and makes everyone uncomfortable.
Tip for Mom: If you cannot agree with your ex, let your doctor know who has final decision-making authority when it comes to medical care. And never argue with your ex about issues relating to a difference in opinion – or lack of communication – in front of your child. Try to work the issue out in private or ask to speak to the doctor outside your child’s presence.
Q. What do you do when things escalate between parents in your office?
A. When it’s bad, I’ll call the parents in together for a meeting (without their child). I’ll let them know that I’m concerned about how their interactions are affecting their child and my ability to care for their child. Sometimes parents just don’t realize the impact of their actions. The American Academy of Pediatrics advises physicians to remain neutral and to focus on providing medical care and advising the family when divorce has negative health impacts on a child. We follow their guidelines.
Tip for Mom: Trust your physician to care for your child medically - and that includes how your divorce is impacting your child’s health - but understand it’s not her job to take sides in your divorce.
Q. Do parents actually ask you to take sides?
A. Yes, though usually not that overtly. It will be a parent asking us to sign an affidavit for them to use in their custody case (DIGC: That sounds pretty overt!) My answer is that I will sign an affidavit giving just the facts - like who brings the child in, and whether they seem to listen to my advice. But I’m not going to give an opinion about who is the “better” parent or who should have custody.
Sometimes a parent will ask if I’m “documenting” what was said during an appointment. This is usually related to one parent repeating an incident that supposedly happened outside of the office. And my response will be “yes, I’ll write down that you said this is what happened.”
Tip for Mom: It’s a good idea to copy your ex on any emails you send to your physician. That way there’s no misunderstanding of what was said. And try to remember your doctor needs to remain neutral and cannot show any bias toward one parent over the other.
Q. What should parents tell their child’s pediatrician about their divorce situation? And what information is just too much?
A. I’ll break it down to 5 main questions that your pediatrician needs answers to:
1. Is there a change in your family dynamics? Your pediatrician needs to know if a family’s situation is changing - whether that’s a trial separation, a divorce, or a remarriage.
2. Will it be a “good” divorce? How you’re communicating as parents, whether you can be in the same room together, how are you interacting in front of your child, can you address issues directly or will everything go through the lawyers.
3. Is there a dispute over physical custody? Your child’s doctor should know whether you’ve agreed on where your children will live and when they’ll see the other parent.
4. Are there disputes over medical decision-making? Pediatricians need to know who will make the decisions if there’s a dispute. And if this hasn’t been worked out legally yet, how will you handle it until then - because this can cause confusion to both the pediatrician and the child.
5. Who is responsible for paying the bills? Once you have an agreement and if it’s in a court order, share that information with your doctor’s billing department.
Dr. Koenig's takeaway: Your child’s pediatrician does not need or want to know the intimate details of your divorce - who wanted it, who’s at fault. Certain things may be relevant - like substance abuse, mental health issues, or sex addiction. If your child is at risk, that’s a need to know. But otherwise, we don’t need the details. Please don’t tell your pediatrician the details to try to get him or her to testify on your behalf; remember that their job is to care for your child.
Thanks, Dr. Koenig! This is such great advice.
Allison Koenig, M.D., a board certified pediatrician, grew up in Atlanta, GA. She is a member of the American Academy of Pediatrics and currently serves as a member of the Children’s Healthcare of Atlanta (CHOA) Community Physician’s Advisor Council. She is a member of Piedmont Pediatrics, one of the premier practices in Atlanta, GA. She also participates in international medical mission trips each year.