How do you handle a situation in which one of a child's divorced parents (who lives out-of-state) wishes to speak with you outside of the appointment?

[SpongeBob DoctorPants]

I have an upcoming visit with a new pediatric patient, who will be brought in by the mother for an in-office visit. The father, who lives in a different state, wishes to be part of the visit by video, and also wants to talk with me outside of the appointment time to give me "all the information", because he believes the mother is going to withhold some important details.

I'm wondering if I should just try calling the father sometime after the initial appointment whenever I have a break in my schedule, or if it would be best to have him schedule an appointment to discuss these things as part of an extended evaluation (if it might be something that takes a while), but then I wonder if there could be an issue related to having a visit with someone who is in a different state where I am not licensed.

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[WisNeuro]

Obtaining collateral information is technically different than providing clinical services. I obtain collateral from family often out of state. In terms of possible familial discord, I usually talk to family members separately anyway, though not in secret with regards to the patient. The big ethical/legal issue would mostly be if the father wants any information and does not have legal custody.

 

[calvnandhobbs68]

I have an upcoming visit with a new pediatric patient, who will be brought in by the mother for an in-office visit. The father, who lives in a different state, wishes to be part of the visit by video, and also wants to talk with me outside of the appointment time to give me "all the information", because he believes the mother is going to withhold some important details.

I'm wondering if I should just try calling the father sometime after the initial appointment whenever I have a break in my schedule, or if it would be best to have him schedule an appointment to discuss these things as part of an extended evaluation (if it might be something that takes a while), but then I wonder if there could be an issue related to having a visit with someone who is in a different state where I am not licensed.

Figure out the custody situation first before the appointment and tell them they need to provide documentation of this. I've had more than one person say they "have joint custody" or whatever but actually don't. If they have joint custody, then yes the father has the right to get information and be part of the appointment. If not (and I'm guessing not in this case because I doubt they do any out of state visitation but who knows) then I'd get a limited amount of collateral (but basically tell him we have 15 min to talk cause I'm here to hear all his little grievances against mom) and tell him he needs to talk to mom for any info about the patient.

Definitely would lead with that you're trying to gather info that would help you treat the kid and any personal problems between himself and mother should be discussed between them. This sounds like a setup for dad bitching for an hour about all the stupid interpersonal stuff going on between him and mom. Could be a huge waste of time. I don't think there's an issue with getting info from someone outside the state since he isn't your patient.

 

[whopper]

Agree with the above.

Clearly figure out who has legal guardianship. Is it one parent or both? As Calvinandhobbs68 wrote get the paperwork to be clear. Also if one parent is not the guardian you can still obtain information from them. Just that sending information is a different matter.

E.g. parent wants to tell me information about a patient and there's no HIPAA release. The parent already knows I'm treating their child. They call me up and tell me they want to speak with me. I can tell them "I can take information from you but I cannot give any," and then tell them to proceed.

Also Calvin was right about the potential huge "waste of time." Family disputes often times involve someone wanting you to be their therapist while they want you to listen to them for hours despite that you are not treating them. You could limit their communication and the time it takes by asking them to write you the information instead of sitting there being their punching bag for an hour.

 

[Candidate2017]

I've run into a handful of similar scenarios as an adult trainee. I'm surprised you've never dealt with this before? The non-custodial parent is likely trying to pull you into the triad and weaponize you against the other parent and child. So, boundaries.

I have the custodial parent call and put the non-custodial parent on speaker during the joint interview portion. I tell them they can raise objections against each other, but they will be tabled, and I will allow each parent 5 minutes towards the end to speak their piece separately. Regardless of legal status, I also tell them my treatment plan requires both parents and child to come to a consensus and communicate with each other regarding treatment, meds, and updates. If they cannot work together in the child's interest, I cannot be on board. Plus, I'm not into passing messages between two adults who are capable of making a human being but incapable of calling each other.

Ultimately, the patient is the child, so if sessions ever turn into bitching sessions for the benefit of the adults, I kindly suggest they seek family therapy. It tends to make them pipe down. Not my horse, not my rodeo, not my job.

Also, scheduling an appointment for the parent veers toward doctor-patient relationship, as opposed to a quick call for collateral. Thank god I will never ever deal with child patients again.

 

[singasongofjoy]

I love the ideas of putting a time-boundary on how much you will talk with dad outside of the joint session that others mentioned (and to make sure everyone knows you will provide a BRIEF, defined period of time chance for each to speak to you independently if they want)). Then you have an easy out if it turns into a griping session. I sometimes suggest that if someone has a lot to say re: what they think is collateral info that I'll send them some standardized measures in the mail to complete and return (because usually need this anyway) and include a short questionnaire of additional questions (e.g., are there other concerns that haven't been previously raised that you think are important to consider as part of treatment, are there any other important things you think we should know about your child?) ....it is much quicker to skim what they've written and see if there is anything substantial than to be stuck on the phone for a call I'm not charging for because it's all part of the 90791 / interview.

 

[clozareal]

I agree about getting custody paperwork before the interview, particularly as this father is out of state and likely has a limited role in taking care of the child. I've heard of clinics where if the parents are divorced, then part of the intake packet is the custody paperwork before the patient can even be seen but that's probably overly cautious.

Then if he has joint custody, then there is no issue speaking with the father who is out of state because he is not the patient. Another reasonable route is to speak to the patient and the mother and put the onus back on the mother to convey this information to the father. If he doesn't have joint custody, then I would not speak with him and advise the mother (or whoever the legal custodian is) that it's up to her how much she wants to share with the father.

 

[SpongeBob DoctorPants]

Thanks, everyone! I appreciate your input.