During a routine hospital visit, a school-aged child looked up at me and asked, “What’s your religion?” My trainee and I exchanged a brief glance before I replied, “As most individuals in Argentina, I was born and raised Catholic,” omitting details about my current beliefs. My trainee, from the Middle East, described the religions in their country. The child was eager to talk and even offered to teach us about Jesus. The father sat quietly beside the bed and did not intervene.The exchange was simple and innocent. However, later, a colleague of another faith confided that they felt uneasy entering the same room and were unsure how to respond in the future. I found myself wondering how we, as clinicians, might better prepare for these moments.In another encounter, a child asked, “Where are you from?”—a question prompted by my accent. The query was not hostile; however, it carried layers of meaning that made me pause before answering. Similar to questions about religion, it required balancing authenticity, professionalism, and boundaries while maintaining trust with the family. Similar questions may also arise in many other forms: “Why is your skin a different color than mine?” “Why do you talk funny?” or “Do you have children?” Each of these inquiries may be developmentally appropriate and well intentioned, but they still place clinicians in the position of deciding how much to self-disclose and how to respond in the moment.Children may ask both identity-based questions, such as those about accent, race, or religion, and personal questions, such as whether a clinician is married or has children. Although these differ in origin, both require sensitivity, boundary awareness, and thoughtful self-disclosure. These encounters are common in pediatrics. Children ask questions more freely than adults, and their curiosity about religion, language, skin color, or family background often emerges suddenly. Parents’ silence or engagement can shape how the moment unfolds, and the continuity of pediatric care means that a single uncomfortable exchange may reverberate for years to come. However, pediatric training rarely prepares clinicians for identity-based questions directed at them. Although not overtly hostile, such inquiries can leave physicians unsettled, especially when professional boundaries or cultural differences are at stake. Surveys show that one-third of residents face identity-based questions at least once a month, and nearly all have witnessed or experienced biased behavior.1,2 Despite their frequency, nearly 90% of trainees report minimal preparation and call for better training and policies.1 While many child questions stem from natural curiosity, some may reflect implicit bias or trigger bias-related reactions in clinicians. Recognizing these feelings and taking a moment to reflect before responding can help preserve empathy and professionalism while promoting mutual understanding.As the US population and workforce diversify, these questions will become more common.3,4 A child’s curiosity may be innocent, but it still requires clinicians to respond in ways that protect both the therapeutic relationship and their boundaries. In contrast, parents may frame questions with implicit bias, demanding a different kind of response. Without preparation, physicians risk eroding rapport, undermining psychological safety, and increasing the risk of burnout.Current frameworks, such as cultural competence, cultural humility,5 and cultural intelligence,6 emphasize the importance of understanding patients and their families. However, they rarely address the reverse: when patients or families direct personal questions at the clinician. Cultural intelligence, defined as the capability to recognize, interpret, and adapt effectively across cultural contexts,6 is applied here to situations in which curiosity or bias is directed toward the clinician. This asymmetry leaves the physicians vulnerable. Federal law protects patients from discrimination by clinicians, but no equivalent legal protection safeguards clinicians from mistreatment by patients. Institutions should establish clear pathways to support clinicians who experience harassment or abuse, while maintaining their professional responsibility to provide safe, equitable care. Simultaneously, recent rollbacks of federal diversity and inclusion programs may erode institutional support.7Cultural competence focuses on acquiring knowledge and skills about different cultures, whereas cultural humility emphasizes ongoing reflection, curiosity, and learning from patients and families.5 Practicing cultural humility involves taking a brief “pause” to clarify meaning before responding, which can prevent misinterpretation and promote connection. A related concept is physician self-disclosure. Research from other disciplines and a recent American Academy of Pediatrics (AAP) clinical report highlight that self-disclosure—the intentional sharing of personal information by a clinician with a patient—requires careful judgment, weighing authenticity against professional boundaries.8 Integrating the principles of thoughtful self-disclosure into training may help normalize and prepare pediatricians for such encounters.Bidirectional cultural intelligence offers a practical framework for navigating these situations. It is the ability to respond thoughtfully in both directions: honoring patient identity while also managing interactions when clinicians themselves become the focus of attention. For younger children, clinicians can respond briefly and with curiosity—for example: “That’s an interesting question—what made you wonder about that today?” When a child asks about skin color, one might reply, “People have different skin colors, just like we have different hair or eye colors, and that makes us unique.” When asked about an accent, a clinician might explain, “I grew up speaking another language, and now I use English every day to care for patients.” With adolescents, physicians may acknowledge the question while setting respectful boundaries: “I appreciate your interest, but what’s most important is how I can support you.” When questions come from parents, clinicians can maintain trust by responding with empathy while redirecting: “I understand why you might ask. Let’s focus on your child’s needs right now” (Table 1).When handled well, these moments can strengthen the physician-family relationship and model respectful dialogue. If handled poorly, they can erode rapport and compromise clinician well-being. To avoid leaving physicians to improvise, institutions should provide standardized strategies and role-play exercises with standardized patients to simulate triadic interactions between children, parents, and clinicians. Upstander training, communication workshops, and curricula on self-disclosure are existing resources that could be adapted for pediatrics.9,10 Institutions should also establish clear policies on when clinicians can set boundaries and provide confidential reporting systems and peer support networks (Table 2).Pediatricians are uniquely positioned to lead this work. Children’s questions create opportunities to model empathy, respect, and boundaries early on. Parents’ silence or complicity can complicate these encounters, requiring physicians to manage both child development and family dynamics. The longitudinal nature of pediatric care means that a single poorly managed moment can affect the clinician-family relationship for years. Moreover, workforce sustainability depends on the well-being of clinicians. Mistreatment and bias from patients are linked to burnout, depression, and turnover.2 Training pediatricians to navigate identity-based encounters and backing them with institutional support is both a moral and strategic imperative.The next time a child asks about my religion, I will still aim to respond with empathy and authenticity. If a child asks about my accent or background, I can acknowledge their observation in a developmentally appropriate way while redirecting them to their care. However, I should not have to navigate these moments alone. Preparing pediatricians for multicultural care must also mean preparing them for when they themselves become the question. By embedding bidirectional cultural intelligence into curricula, policies, and institutional culture, we can protect clinician well-being, preserve trust, and sustain a workforce prepared to meet families where they are located.
Diego R. Hijano (Thu,) studied this question.