Wash your hands!
so you don’t get
Wash your hands!
so you don’t get
Here’s a rundown of reasons to love pediatrics:
Reason Number 1: Pediatrics is about prevention.
Reason Number 2: Tickling toddler toes.
Reason Number 3: Making a connection with patient & parent
Reason Number 4: Shopping my brain for tailored advice for patients.
Reason Number 5: New Stuff
Reason Number 6: Being anti-pain
Reason Number 7: Medicine in the age of the internet.
Reason Number 8: Cultural diversity in my practice.
Reason Number 9: Research and information gathering.
Reason Number 10: Toys.
Reason Number 11: Loyal adolescent male patients.
Reason Number 12: Twins.
Reason Number 13: My partners.
Reason Number 14: Books for patients and parents
Reason Number 15: Books 2: Books for doctors by doctors
Reason Number 16: A-Ha! Moments
Reason Number 17: Kid’s Hair
Reason Number 18: Pediatrics is a specialty
Reason Number 19: Making a specialty within pediatrics
Reason Number 20: Concierge medicine @ home
Reason Number 21: Foreign bodies
Reason Number 22: Tricks of the trade
Reason Number 23: My community
Reason Number 24: New Parents
Reason Number 25: Follow-up Phone Calls
Reason Number 26: Intuition
Reason Number 27: Patience
Reason Number 28: Rashes
Reason Number 29: Life out of the office
Reason Number 30: Spouse support
Reason Number 30: Spouse Support
The saying goes that it takes a village to raise a child. A physician also needs the support of a village to do the job of medicine. Running a pediatric practice is an on-the-job MBA. Medical school and residency taught me many things, but accounting, marketing, public relations, employment law, OSHA and CLIA regulations were not part of my curriculum.
My husband in the yin to my yan, the peas to my carrots, the sunrise to my sunset, and the bass to my soprano. His education was about all those things I’ve learned through experience. In his former life, he ran a “village”. Our strengths compliment each other in the business. So it was natural to ask him to run the operations/management/administrative side of my practice.
Working together is not a cakewalk. The division of responsibilities is dynamic. I’ve stepped on his toes and he’s stepped on mine, and despite our best intentions work comes home with us from time to time. Our tendency is to take shifts both at home and when the office needs our attention outside of our usual 9-5. That flexibility enables him to do pick-ups at school, errands for home and office simultaneously, and meet the washing machine repairman. Sometimes he’ll work after the kids go to bed when all is calm and quiet.
My spouse is the extrovert of the two of us which is ironic since he spends most of his day at his desk filing insurance claims, keeping me and my partners on track with CME, credentials, and scheduling, and juggling all tasks that happen behind the scenes. It’s a treat to hear him talking to patients and parents when he’s able. He’s patient, kind and positive. He gives our office a flow of happy energy even when we’re giving shots and tending to lots of sick children.
At the end of the day, I enjoy the debriefing and stories we share. Even the days when I’m irritated with him, I know he has my back, our vision for the business is similar, and how hard we both work to pull this all off.
Reason Number 28: Rashes
My new partner makes me chuckle every time she reaches for Hurwitz‘s Clinical Pediatric Dermatologytextbook or Krowchuk’s Pediatric Dermatology. With ardent effort, she tries to match reality with textbook – no small task. Since skin is the largest, most visible organ, rashes are bread and butter pediatrics, and no two are ever alike. Despite the intensity of pediatric training, outpatient dermatology training takes a backseat to other maladies. New pediatricians usually get their training on the job, and with experience become proficient in treating this common complaint.
Dermatology fascinates me for six reasons:
1. Disease is visible to the naked eye or touch – no microscope, lab test, CT scan needed
2. Parents can determine whether the malady is getting better from observation.
3. Treating skin disease also treats self-esteem in some cases. Example: acne vulgaris
4. I love the language of dermatology – molluscum, papulosquamous, acanthosis nigricans
5. Pediatric rashes can be clues to other disease
6. Each new rash is a chance to learn another variation on dermatology.
Reason Number 26: Intuition.
“It is always with excitement that I wake up in the morning wondering what my intuition will toss up to me, like gifts from the sea. I work with it and rely on it. It’s my partner.” Dr. Jonas Salk
For some patient encounters, evidence-based, rooted –in- science medicine doesn’t answer all the questions. It is during these times that I rely on my silent consultant, intuition. My logical mind would like to resist these encounters, but an intuitive “hit” is like IV caffeine to the rest of my brain. And like Dr. Salk said, “Intuition will tell the thinking mind where to look next.”
A-ha moments are born of intuitive hits. Early in my career, I diagnosed a sweet, eight year old with leukemia. She was pale and appeared ill, but she could have looked that way for a number of reasons. Even the oncologist I referred this patient to noted that she could be sick from a wicked viral infection. A bone marrow biopsy confirmed the diagnosis that I had suspected before her blood count came back. This patient’s mother came to me one day after her daughter was treated and in remission and asked me how I knew that her daughter had leukemia. I didn’t have a good answer – leukemia is one of those illnesses a general pediatrician will see lots of in residency but very few in private practice. (Fortunately!)
Most hunches about my patients and their families are not this extreme. I use this radar to strike a balance between what parent’s desire from a medical encounter and what’s called for depending on the complaint. Disharmony in families will lead to visits to my office. While surveys such as those used by Mary Caserta, MD and Peter Wyman PhD in their research connecting childhood illness to family stress are used in controlled settings, I have found that my own intuition is a good barometer. Sometimes I’m the tie-breaker is a difference of opinion between spouses or other family members. Sometimes those “oh-by-the-way” hand on the door moments are parents reaching out for a sounding board.
Maybe intuition is just accumulating experience, but I doubt it. Hunches and gut feelings remind me that I’m not in this medicine business by myself – that some other force is at work as I navigate my way through the lives of my patients.
Reason Number 27: Patience
My residency director described me as zealous. I was a bit taken back when he announced this at our graduation dinner. To me the term meant militant maybe even with terrorist tendencies – Yikes! Not exactly the touchy-feely pediatrician you would take your babies and children to, huh? On introspection with the help of Miriam – Webster, I’ve come to realize the postive aspects of being zealous – ardent, eager, passionate. That impetuous side works well in emergencies and in critical care settings, and knows how to prioritize information and tasks.
Yet most of pediatrics is not emergencies, and I have had to learn the fine art of patience. Parenthood has taught me to slow down and wait, but medicine, pediatrics, and patients – despite the breakneck speed of practice – has drilled lessons of composure into me, too.
Patience is waiting for a toilet-training two year old to return from the bathroom. It is letting a parent tell his or her reason for the appointment in more than 20 seconds before interrupting. Patience is knowing that Roseola takes a big fever before declaring itself with a rash. Patience is waiting for a phone call from a subspecialist. It is coaching a reluctant patient through an ear examine, throat swab, or suture removal. Being patient is embracing flexibility and letting the day flow. Patience is gentleness. presence and listening. I hope that’s how my patients remember me.
Reason Number 25: Call Backs.
Yesterday, I was sitting on a bench at my son’s school waiting for him to finish his extracurricular activities when one of the front desk staff approached me.
“Do you remember calling me about my son? He’s 18 now, but in the third grade he had a kidney stone, and you called while we were on vacation to check on him.”
I wracked my brain – ten years and close to 40,000 patient visits later, I was having a difficult time recalling the call.
“I’ll never forget that you called us then.”
Certain patients niggle my brain. I’ll think about them when I’m in the car or shopping in the grocery store. Sometimes I worry about them. Sometimes I’m just curious to see how a visit to a subspecialist went. When I can, I like to pick up the phone to check on them. I wish I called back more, but it’s just not possible in the controlled chaos that is my pediatric office.
Calling back takes effort – finding a phone number, making the space for a couple of quiet minutes when I won’t be interrupted. It’s worth the effort, the instantaneous feedback. Sometimes e-mail suffices – although phone calls feel more personal. In a perfect world, I’d call all my patients back – check to see if that antibiotic helped the ear infection, hear how the jaundiced newborn was eating, follow-up on the discharge from the hospital for H1N1 – the response would enhance my medical care.
Reason Number 24: New parents. My primary hospital is a 120 bed community facility with an active labor and delivery unit. Approximately 80 families add a new member there each month. Despite the pushes and pulls of running a growing (outpatient) pediatric practice, I have maintained my hospital privileges to see the newborns and their families. For most , a new baby is a very happy time, and I thrive on that optimism.
Especially for first time parents, advice abounds. From grandparents. From friends. From the medical staff. Even from the stranger ahead in the check-out line in Target. With more access to information, parents are more well-read than ever. Despite the amount of information or maybe because of the volumes of it, new parents have lots of questions. The perinatal period opens a window in the minds of new parents, and they are often hungry for valid opinions. My role is to coach – go through the pros and cons of a decision – help them test the waters of their new roles – with common sense and objectivity.
My own children have nurtured the coach in me. They’ve taught me flexibility, and to see that they are people with opinions, too. They’ve also taught me that realism and common sense. Prior to my firstborn, I quoted all the statistics about the values of breastfeeding to my new parents. The evidence was so clearly stacked that I bought a wiz bang breast pump anticipating my new role as working, breastfeeding mother. That pump never left the box. Firstborn Will came out with clear intentions that the claustrophobic work of nursing was not for him – he cried and cried every time I tried to latch him. I cried and cried, too, feeling my first taste of “failure” as a pediatrician/mom. A weak milk supply didn’t help matters, either.
That experience was the foundation of the spiel I give to new parents. Each parent has an inner voice or gut feeling that tells them the right way to nurture their child – pay attention to that voice as it is rarely wrong. Watching and guiding parents to find their groove is a very rewarding part of my job.
Reason Number 23: Community. In my first pediatric practice, my senior partner told me “Take care of your community, and they will take care of you.” Heeding his advice, I took my dry cleaning to the family business who brought their six children to our practice, and I frequented other local businesses with young families and children. Now in my own practice in another community, I still value that wisdom from almost 15 years ago. This informal network has built a group of patients that I enjoy seeing in my office, but also around town.
Reason Number 20: Concierge Medicine @ home
On more than one occasion, I have treated my own children. The lines get a little blurry between when I doctor my children as a mom and when I work on them as a physician. The afternoon that my then five year old discovered yellow jackets chase you and stung him 13 times was a mom-treated incident. Intuitively, I dunked my frightened son in a big tub of lukewarm water and baking soda while I whacked the straggling yellow jackets.
On another occasion, I had my MD hat on firmly as I watched my youngest struggle with RSV (respiratory syncytial virus). With his wheezing growing more and more audible from the rotten virus, Harry got more and more still as he worked harder to breathe. I suspected this fourth night into his illness that we were in for a rough night, and I borrowed the pulse oximeter from the office to watch his oxygen levels. He hovered in the low 90% range for most of the night while his chest retracted around his ribcage. I pulled out my mom care, too, with lots of humidity and pushing him to drink enough electrolyte solution so that he wouldn’t get dehydrated. The next two nights were equally tough as I watched his oxygen level bounce close to the point where I thought we needed to go to the hospital for oxygen and further treatment. I kept my partners up to date on his progress since we knew he was on the bubble for admission. Tired and second guessing myself , I noticed a pretty good improvement on the seventh night, and knew we were pulling through.
Harry’s older brother, Will, got a taste of mom in MD mode as a vacation at the beach was ending. In a game of beat-the-clock, my husband and I were trying to get us packed up and checked out when we discovered that young Will had shoved one of my broken earrings up his nose. Why he chose that moment we’ll never know, but I immediately went into action to avoid an ED visit and still check-out on time. Will knew I meant business as I came after him with eyebrow tweezers and a headlock. In retrospect, his cooperation was the key to the success of the earring-ectomy. We pulled away from our beach rental with minutes to spare as I gripped the pearl – a souvenir from the trip that I hadn’t anticipated.
The knack of concierge medicine at home is having second opinions close by. My husband is an integral part of that equation as are my partners. Even if I think I know the answer, I lean on this support system to validate my thoughts. Occasionally I feel silly when I ask for back-up but it’s a small price to pay to do the right thing for my most important patients.