When doctors and parents disagree: royal college issues advice on dealing with conflictBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1835 (Published 18 April 2019) Cite this as: BMJ 2019;365:l1835
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This new advice from the RCPCH regarding managing conflicts between parents and clinicians is long-called for and will hopefully help to prevent relationships from becoming strained when disagreements occur. With the two recent high profile cases of Alfie Evans and Charlie Gard taking place within a year of one another, it is important to reinforce that they should still be seen as a last resort to ensure that relationships between families and doctors are upheld whilst retaining parental autonomy as much as possible.
Throughout this guidance there rightly appears to be one major underlying theme; communication. It is easy to forget the effect that something as simple as communication can have on the way parents feel about the clinicians treating their child. Better communication, not only with families, but also between members of staff will ensure that everybody is on the same page and no mixed-messages are given. It can be these mixed messages which may result in confusion and lack of trust in the healthcare team, making it more likely for conflicts to arise. If parents feel as though they adequately understand the reasons behind decisions, that their opinions are valued and they receive a consistent message from the team, there is likely to be a greater level of faith in those who are caring for their child.
This should also hopefully help to prevent the public demonstrations and media coverage that were seen in the cases of Charlie Gard and Alfie Evans . If parents feel listened to and that their voice and opinion is heard, there will be less need for them to feel as though they have to turn to support from the public. Keeping these cases between the patient, the healthcare team and the family will prevent the indignity of becoming a subject of the news and national opinion.
At the end of the day, everybody wants what they think is best for the child in question. It is natural for our opinions to differ from one another however if this guidance is implemented into practice and better communication becomes commonplace, it will hopefully help to improve relationships between parents and doctors when conflict arises.
1) Rimmer A. When doctors and parents disagree: royal college issues advice on dealing with conflict. BMJ 2019 365:l1835
2) Great Ormond Street Hospital for Children NHS Foundation Trust v Yates  4 W.L.R. 131
3)Evans v Alder Hey Children's NHS Foundation Trust  4 WLUK 624
4) Norton S, Tilden V, Tolle S et al. Life Support Withdrawal: Communication and Conflict. Am J Crit Care 2003; 12(6): 548-555.
5) Shepherd A . Anger as Alfie’s Army protests outside Alder Hey. BMJ 2018;361:k1801
Competing interests: No competing interests