Setting Boundaries with Divorced Parents Making Medical Decisions

Separated or divorced parents making medical decisions for their children should be able to communicate civilly. Yet it doesn’t always work this way. Most primary care and pediatric practices see minor patients daily whose parents aren’t together, don’t get along, and are unable to communicate about decisions for the child.  

Physicians, APRNs, PAs, and office staff who interact with these battling parents often feel uncertain about how to respond to their frequent demands. Parents may expect you to: 

• • Take their side, 
  • “Mediate” their disputes,  
  • Accommodate their inappropriate requests, or  
  • Read and interpret lengthy divorce documents. 

Parents jockeying for control may act aggressively if you don’t do what they want. Their inappropriate demands, unnecessary phone calls and emails, and hostile behavior frequently disrupt practice operations.  

Common Demands Parents Make 

When MICA members need guidance on how to manage these situations, they often call the MICA's Risk Management Hotline and talk to MICA’s Risk Team. While every Hotline call is different, most practices say they hear one or more of the following demands from divorced parents who don’t get along:  

• • Don’t give the other parent access to the child’s medical records. 
    
    
  • Don’t let the other parent’s family member/spouse make appointments or bring the child for an office visit. 
    
    
  • I want the practice to call me whenever the other parent makes an appointment for the child. 
    
    
  • When someone else brings the child for an appointment, I want the clinician to call/email me afterward and tell me everything that happened (including what the other parent said). 
    
    
  • I wasn’t present at the appointment, but I object to the treatment plan, vaccinations, or other medical care that the other parent agreed to.  

Setting Boundaries for Your Practice 

Physicians, PAs, APRNs, and their medical practices are in the business of providing health care. They are not required to interpret legal documents or act as middlemen for high-conflict, divorced parents who can’t agree on medical decisions. When faced with demands like those listed above, clinicians and staff alike are entitled to set boundaries by:  

• • Explaining that the practice will give both parents access to the child’s medical records (unless the practice has on file a current court order signed by a judge that specifically prohibits a parent from accessing medical records); 
    
    
  • Declining to notify a parent whenever the other parent makes an appointment; 
    
    
  • Declining to summarize, discuss, or reexplain what happened during the child’s appointment for the parent who wasn’t present; and/or 
    
    
  • Telling the parent who wasn’t present that he/she may read medical record notes to obtain current information about the child’s medical treatment. 

Managing Parent Expectations Up Front 

Managing parent expectations early can help you set boundaries and may decrease confrontations with angry parents later. Consider:  

• • Outlining your expectations in a patient/parent code of conduct, a patient/parent responsibilities document, or a practice policy; 
    
    
  • Posting the document in the office and on the website/portal;  
    
    
  • Distributing it to parents with other initial visit documents; and   
    
    
  • Requesting that parents sign the document to show their agreement.  

What Should the Ground Rules Be? 

Whether in a policy, a code of conduct, or a responsibilities document, consider communicating the following information to divorced or separated parents: 

• • Sharing a child requires parents to communicate civilly about health care decisions  for the child.
     
  • Under no circumstances will clinicians or staff act as liaisons between parents who can’t communicate civilly. 
    
    
  • Court-approved parenting plans, divorce decrees, and/or other family court orders often specify parent obligations to communicate with each other about their child’s health care. Parents should read and follow these orders. 
     
  • Practice employees will not interpret or explain parenting plans, divorce decrees, or family court orders.  
    
    
  • Parents who are unable to communicate civilly with each other about their child’s health care should consult their attorney about whether to seek additional orders from the court.  
    
    
  • The practice expects that the parent who makes the appointment and brings the child for care will communicate with the other parent about what happened at the appointment. 
    
    
  • Unless prohibited by current court order or applicable state or federal law, the practice will ensure both parents have access to the child’s medical record. 
    
    
  • Practice employees will not restate, rediscuss, or reexplain (by telephone, email, or in-person) what happened during the child’s appointment for or with the parent who was not present. If the absent parent believes the parent who brought the child for care is not sharing accurate or complete information about a medical issue, then the absent parent should contact their attorney or the court. 
    
    
  • Divorced/separated parents of minor patients must provide the practice with a copy of the current parenting plan, divorce decree, or family court orders.  
    
    
  • Divorced/separated parents of minor patients must notify the practice of changes in address or payment methods, including changes in the child’s health insurance.
    
    
  • If either parent’s behavior conflicts with these policies, disrupts practice operations, or interferes with care, the practice may ask the parents to seek care elsewhere for the child.

The Bottom Line 

Physicians, APRNs, and PAs rely on parents of minor patients to communicate about medical decisions. Practices are not required to be a “go-between” for parents who can’t or won’t communicate. Managing parent expectations up front and setting boundaries may improve practice-parent relationships and ensure that clinicians have enough time to provide care for other patients.