Skip to main content
  • 347 Accesses

Abstract

In this chapter, we explore the role that values alignment plays in shaping the well-being of pediatricians. We begin by defining what values alignment is, as well as linking it to self-determination theory and authenticity in professional practice. We then identify three key areas in which values alignment can pose a challenge. At the micro, individual level, values alignment can become a point of contention in personal interactions of pediatricians with their patients and their families, or while navigating challenges pertaining to work-life balance. At the meso, institutional level, values alignment can be threatened by administrative pressures and dissonance between personal and organizational values. Finally, macro, structural level challenges to values alignment stem from policies and the cultural contexts that pediatricians work within. Our overall goal in this chapter is to demonstrate that while values alignment is primarily experienced at the personal level, it is largely shaped by organizational and socio-cultural factors that extend far beyond pediatricians’ control. We also provide recommendations on how values alignment can be facilitated to promote well-being among pediatricians.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pololi L, Kern DE, Carr P, Conrad P, Knight S. The culture of academic medicine: faculty perceptions of the lack of alignment between individual and institutional values. J Gen Intern Med. 2009;24(12):1289–95. https://doi.org/10.1007/s11606-009-1131-5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Halstead T. Learning and teaching about values: a review of recent research. Camb J Educ. 2010;30(2):169–202. https://doi.org/10.1080/713657146.

    Article  Google Scholar 

  3. Spencer-Oatey Ž. Conceptualizing culture and its Impabebct on behavior. Cultural competence in applied psychology. Cham: Springer International; 2018. p. 211–41.

    Google Scholar 

  4. Trybou J, Gemmel P, Desmidt S, Annemans L. Fulfillment of administrative and professional obligations of hospitals and mission motivation of physicians. BMC Health Serv Res. 2017;17(1):28. https://doi.org/10.1186/s12913-017-1990-0.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gagné D. Self-determination theory and work motivation. J Organ Behav. 2005;26(4):331–62. https://doi.org/10.1002/job.322.

    Article  Google Scholar 

  6. Deci EL, Ryan RM. The “what” and “why” of goal pursuits: human needs and the self-determination of behaviour. Psychol Inq. 2000;11:227–68.

    Article  Google Scholar 

  7. Guertin C, Barbeau K, Pelletier L, Martinelli G. Why do women engage in fat talk? Examining fat talk using self-determination theory as an explanatory framework. Body Image. 2017;20:7–15. https://doi.org/10.1016/j.bodyim.2016.10.008.

    Article  PubMed  Google Scholar 

  8. Mărginean CO, Meliţ LE, Chinceşan M, Mureşan S, Georgescu AM, Suciu N, Azamfirei L. Communication skills in pediatrics—the relationship between pediatrician and child. Medicine. 2017;96(43):e8399.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aarthun A, Øymar KA, Akerjordet K. Parental involvement in decision-making about their child’s health care at the hospital. Nurs Open. 2018;6(1):50–8. https://doi.org/10.1002/nop2.180.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Boland L, Kryworuchko J, Saarimaki A, Lawson ML. Parental decision making involvement and decisional conflict: a descriptive study. BMC Pediatr. 2017;17(1):1–8.

    Article  Google Scholar 

  11. Kientz JA. Understanding parent-pediatrician interactions for the design of health technologies. In: Proceedings of the 1st ACM International Health Informatics Symposium; 2010. p. 230–9.

    Chapter  Google Scholar 

  12. Hough-Telford C, Kimberlin DW, Aban I, Hitchcock WP, Almquist J, Kratz R, O’Connor KG. Vaccine delays, refusals, and patient dismissals: a survey of pediatricians. Pediatrics. 2016;138(3):e20162127.

    Article  PubMed  Google Scholar 

  13. Sisk BA, DuBois J, Kodish E, Wolfe J, Feudtner C. Navigating decisional discord: the pediatrician’s role when child and parents disagree. Pediatrics. 2017;139(6):e20170234.

    Article  PubMed  Google Scholar 

  14. Walker C. Makayla Sault, earlier First Nations child who refused chemo, relapsed: doctor. CBC News. 2014. https://www.cbc.ca/news/indigenous/makayla-sault-earlier-first-nations-child-who-refused-chemo-relapsed-doctor-1.2787249. Accessed 6 Nov 2020.

  15. van der Heide A, van der Maas PJ, van der Wal G, Kollée LA, de Leeuw R, Holl RA. The role of parents in end-of-life decisions in neonatology: physicians’ views and practices. Pediatrics. 1998;101(3):413–8. https://doi.org/10.1542/peds.101.3.413.

    Article  PubMed  Google Scholar 

  16. Raja N. A pediatrician’s survival story: remembering the children. MedPage Today. 2014. https://www.kevinmd.com/blog/2014/02/pediatricians-survival-story-remembering-children.html. Accessed 6 Nov 2020.

  17. Starmer AJ, Frintner MP, Freed GL. Work-life balance, burnout, and satisfaction of early career pediatricians. Pediatrics. 2016;137(4):1–12. https://doi.org/10.1542/peds.2015-3183.

    Article  Google Scholar 

  18. Penwell-Waines L, Ward W, Kirkpatrick H, Smith P, Abouljoud M. Perspectives on healthcare provider well-being: looking back, moving forward. J Clin Psychol Med Settings. 2018;25(3):295–304. https://doi.org/10.1007/s10880-018-9541-3.

    Article  PubMed  Google Scholar 

  19. McClafferty H, Brooks A, Chen M, Brenner M, Brown M, Esparham A, Maizes V. Pediatric integrative medicine in residency program: relationship between lifestyle behaviors and burnout and wellbeing measures in first-year residents. Children. 2018;5(4):54. https://doi.org/10.3390/children5040054.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mihailescu M, Neiterman E. A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America. BMC Public Health. 2019;19(1):1363. https://doi.org/10.1186/s12889-019-7661-9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Weigl M, Schneider A, Hoffmann F, Angerer P. Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians. Eur J Pediatr. 2015;174(9):1237–46.

    Article  CAS  Google Scholar 

  22. Freed GL, Moran LM, Van KD, Leslie LK. Current workforce of general pediatricians in the United States. Pediatrics. 2016;137(4):e20154242.

    Article  PubMed  Google Scholar 

  23. American Medical Association. How medical specialties vary by gender. 2015. https://www.ama-assn.org/residents-students/specialty-profiles/how-medical-specialties-vary-gender. Accessed 7 Nov 2020.

  24. Starmer AJ, Frintner MP, Matos K, Somberg C, Freed G, Byrne BJ. Gender discrepancies related to pediatrician work-life balance and household responsibilities. Pediatrics. 2019;144(4):e20182926.

    Article  PubMed  Google Scholar 

  25. Linzer M, Harwood E. Gendered expectations: do they contribute to high burnout among female physicians? J Gen Intern Med. 2018;33(6):963–5. https://doi.org/10.1007/s11606-018-4330-0.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tawfik DS, Profit J, Webber S, Shanafelt TD. Organizational factors affecting physician well-being. Curr Treat Options Pediatr. 2019;5(1):11–25. https://doi.org/10.1007/s40746-019-00147-6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Pololi LH, Civian JT, Brennan RT, Dottolo AL, Krupat E. Experiencing the culture of academic medicine: gender matters, a national study. J Gen Intern Med. 2013;28(2):201–7. https://doi.org/10.1007/s11606-012-2207-1.

    Article  PubMed  Google Scholar 

  28. Juengst SB, Royston A, Huang I, Wright B. Family leave and return-to-work experiences of physician mothers. JAMA Netw Open. 2019;2(10):e1913054. https://doi.org/10.1001/jamanetworkopen.2019.13054.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hall CB, Brazil K, Wakefield D, Lerer T, Tennen H. Organizational culture, job satisfaction, and clinician turnover in primary care. J Prim Care Community Health. 2010;1(1):29–36.

    Article  PubMed  Google Scholar 

  30. Testa MR. Satisfaction with organizational vision, job satisfaction and service efforts: an empirical investigation. Leadership Org Dev J. 1999;20(3):154–61. https://doi.org/10.1108/01437739910268424.

    Article  Google Scholar 

  31. Grossman Z, Chodick G, Kushnir T, Cohen HA, Chapnick G, Ashkenazi S. Burnout and intentions to quit the practice among community pediatricians: associations with specific professional activities. Isr J Health Policy Res. 2019;8(1):2. https://doi.org/10.1186/s13584-018-026802.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Orfi D. The business of health care depends on exploiting doctors and nurses. NY Times. 2019. https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html. Accessed 6 Nov 2020.

  33. Aristizabal P, Fuller S, Rivera R, Beyda D, Ribeiro RC, Roberts W. Improving paediatric cancer care disparities across the United States-Mexico border: lessons learned from a transcultural partnership between San Diego and Tijuana. Front Public Health. 2015;3:1–9. https://doi.org/10.3389/fpubh.2015.00159.

    Article  Google Scholar 

  34. DeCamp LR, Kuo DZ, Flores G, O’Connor K, Minkovitz CS. Changes in language services use by US paediatricians. Paediatrics. 2013;132(2):396–406. https://doi.org/10.1542/peds.2012-2909.

    Article  Google Scholar 

  35. Logan DC, Rodriguez A. Well leaders lead well: how to create and sustain a culture of wellness during COVID-19 and beyond. In: Social science research network; 2020. p. 1–33. https://doi.org/10.2139/ssrn.3680060.

    Chapter  Google Scholar 

  36. Shanafelt TD, Makowski MS, Wang H, Bohman B, Leonard M, Harrington RA, Trockel M. Association of Burnout, professional fulfillment, and self-care practices of physician leaders with their independently rated leadership effectiveness. JAMA Netw Open. 2020;3(6):e207961. https://doi.org/10.1001/jamanetworkopen.2020.7961.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678–85.

    Article  PubMed  Google Scholar 

  38. Ford Foundation. Diversity, equity, and inclusion: annual report. 2019. https://www.fordfoundation.org/media/5533/2019-dei-update.pdf. Accessed 6 Nov 2020.

  39. Madrid P, Schacher SJ. A critical concern: pediatrician self-care after disasters. Pediatrics. 2006;5(3):454–7. https://doi.org/10.1542/peds.2006-0099V.

    Article  Google Scholar 

  40. Mills CW. The sociological imagination. Oxford: Oxford University Press; 2000.

    Google Scholar 

  41. Becker HS, editor. Boys in white: student culture in medical school. Piscataway, NJ: Transaction Publishers; 2002.

    Google Scholar 

  42. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90(6):718–25.

    Article  PubMed  Google Scholar 

  43. Eiser AR. The ethos of medicine in postmodern America: philosophical, cultural, and social considerations. Lexington Books; 2013.

    Google Scholar 

  44. Worley P, Prideaux D, Strasser R, March R, Worley E. What do medical students actually do on clinical rotations? Med Teach. 2004;26(7):594–8. https://doi.org/10.1080/01421590412331285397.

    Article  PubMed  Google Scholar 

  45. Mihalic AP, Dobbie AE, Kinkade S. Cultural competence teaching in U.S. paediatric clerkships in 2006. Acad Med. 2007;82(6):558–62. https://doi.org/10.55897/ACM.0b013e3180555ace.

    Article  PubMed  Google Scholar 

  46. Maksimowski K, Massarella D, Ghori A, Ng H. Implementing a self-developed cultural competency workshop in paediatric residency and assessing outcomes. Acad Pediatr. 2016;16(6):47–8. https://doi.org/10.1016/j.acap.2016.05.120.

    Article  Google Scholar 

  47. Dabney BW, Kalisch BJ. Nurse staffing levels and patient-reported missed nursing care. J Nurs Care Qual. 2015;30(4):306–12. https://doi.org/10.1097/NCQ.0000000000000123.

    Article  PubMed  Google Scholar 

  48. Fellin M, Desmarais C, Lindsay S. An examination of clinicians’ experiences of collaborative culturally competent service delivery to immigrant families raising a child with a physical disability. Disabil Rehabil. 2015;37(21):1961–9. https://doi.org/10.3109/09638288.2014.993434.

    Article  PubMed  Google Scholar 

  49. Grandpierre V, Nassrallah F, Potter BK, Fitzpatrick EM, Thomas R, Taylor J, Sikora L. Examining cultural competence in pediatric hearing loss services: a survey. Deaf Educ Int. 2019;21(4):174–94. https://doi.org/10.1080/14643154.2019.1589075.

    Article  Google Scholar 

  50. Hendson L, Reis MD, Nicholas DB. Health care providers’ perspectives of providing culturally competent care in the NICU. J Obstet Gynecol Neonatal Nurs. 2015;44(1):17–27. https://doi.org/10.1111/1552-6909.12524.

    Article  PubMed  Google Scholar 

  51. Murphy JE, Washington D, Ziming X, Paasche-Orlow MK, Drainoni ML. Identifying and addressing language needs in primary care: a pilot implementation study. J Racial Ethn Health Disparities. 2018;6(3):505–16. https://doi.org/10.1007/s40615-018-00549-6.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Arauz Boudreau AD, Kurowski DS, Gonzalez WI, Dimond MA, Oreskovic NM. Latino families, primary care, and childhood obesity: a randomized controlled trial. Am J Prev Med. 2013;44(3):S247–57. https://doi.org/10.1016/j.amepre.2012.11.026.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Banerjee AT, Watt L, Gulati S, et al. Cultural beliefs and coping strategies related to childhood cancer: the perceptions of south Asian immigrant parents in Canada. J Pediatr Oncol Nurs. 2011;28(3):169–78. https://doi.org/10.1177/1043454211408106.

    Article  PubMed  Google Scholar 

  54. Lee SY, Weiss SJ. When east meets west: intensive care unit experiences among first-generation Chinese American parents. J Nurs Scholarsh. 2009;41(3):268–75. https://doi.org/10.1111/j.1547-5069.2009.01290.x.

    Article  PubMed  Google Scholar 

  55. Leslie LK, Plemmons D, Monn AR, Palinkas LA. Investigating ADHD treatment trajectories: listening to families’ stories about medication use. J Dev Behav. 2007;28(3):179–88. https://doi.org/10.1097/DBP.0b013e3180324d9a.

    Article  Google Scholar 

  56. Ragavan MI, Griffith KN, Cowden JD, Colvin JD, Bair-Merritt M. Parental perceptions of culturally sensitive care and well-child visit quality. Acad Pediatr. 2020;20(2):234–40. https://doi.org/10.1016/j.acap.2019.12.007.

    Article  PubMed  Google Scholar 

  57. Rule ARL, Reynolds K, Sucharew H, Volvk B. Perceived cultural competency skills and deficiencies among paediatric residents and faculty at a large teaching hospital. Hosp Pediatr. 2018;8(9):554–69. https://doi.org/10.1542/hpeds.2017-0110.

    Article  PubMed  Google Scholar 

  58. Mayes C, Kerridge I, Habibi R, Lipworth W. Conflicts of interest in neoliberal times: perspectives of Australian medical students. Health Sociol Rev. 2016;25(3):256–71.

    Article  Google Scholar 

  59. Pearson R. What a pediatrician can do for a child seeking asylum—and what she can’t. The New Yorker. 2019. https://www.newyorker.com/news/dispatch/what-a-pediatrician-can-do-for-a-child-seeking-asylum-and-what-she-cant. Accessed 6 Nov 2020.

  60. Wong K. 40 Empowering quotes from Dare to Lead by Brené Brown. The Millennial Grind. 2020. https://millennial-grind.com/40-empowering-quotes-from-dare-to-lead-by-brene-brown/. Accessed 18 Nov 2020.

  61. Thomas LR, Ripp JA, West CP. Charter on physician well-being. JAMA. 2018;391(15):1541–2. https://doi.org/10.1001/jama.2018.1331.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elena Neiterman .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Neiterman, E., Ladha, R. (2023). Values Alignment. In: Webber, S., Babal, J., Moreno, M.A. (eds) Understanding and Cultivating Well-being for the Pediatrician. Springer, Cham. https://doi.org/10.1007/978-3-031-10843-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-10843-3_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-10842-6

  • Online ISBN: 978-3-031-10843-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics