Having recently completed a 6 week
rotation for Pediatrics, in which I saw numerous children from the 2-hour
newborn to the 18 year-old needing a sports physical, I was quite impressed
with the depth of knowledge required to be a pediatrician. I often joke with my
brother's girlfriend, who is a veterinary technical assistant, that being a
doctor should be simple, you are just responsible for one species. When it
comes to taking care of kids, however, the idea that they are all Homo sapiens
somehow is just too hard to believe. Developmentally complex, children can be
categorized by certain physical and cognitive milestones, but in reality, this
is just a snap shot reflection of the person they currently are, and may have no
bearing on the adult they will become. Nurturing and caring for our youth is
something near and dear to my heart. Having grown up with all younger cousins,
I literally saw the growth of my relatives from diapers, to tricycles and rec
soccer, to finally graduating high school and moving on to college. If I were
to tell you that the most important part of their physical maturation was
constant oversight from a pediatrician via well child checks, sports physicals,
the occasional visit during a tough cold, or getting comfort for some bumps and
bruises and that really weird rash, you might think this to be a grand
overstatement. But take a closer look and what you might find instead is a
relationship of trust whereby the pediatrician or family physician nurtured the
growth of a child by being a positive presence, someone who cared.
After observing several visits with UVa
general pediatricians, it became very obvious that the majority of our
discussions revolved not around an illness or presenting complaint (even if
there was an acute problem), but on how a kid was doing in life. What sports
did they play, were they involved in dance or art, how much were they sleeping,
did they have any problems with their diet- too much candy, food intolerances,
not eating enough vegetables, binging on ice cream and Chinese food, how was
life at school, did they have close friends, if they had siblings what was
their relationship like, did they get to travel to another state or country,
what did they want to do when they grew up, what was the coolest thing they had
done in the past week? Taking a history was so far removed from asking about
quality, duration and onset of pain, or reciting a laundry list of questions
for a complete review of systems. Even when these components where required as
part of our visit, it was accompanied by discussions about total well being:
social, spiritual, physical, and emotional.
As vulnerable as I have become during
my years of medical school, I often tell people that I see a psychologist every
2-4 weeks for an hour at a time to simply talk about my life, review my
well-being and make sense of any thoughts or doubts that are going through my
head. While this relationship works for me, what I encourage of everyone is to
find that person in your life with whom these types of discussions can occur,
completely safe, secure and free of judgment. It certainly does not have to be
with a trained psychologist or even a family member or friend, the arrangement
and sense of true acceptance are all that matters. In thinking about the pediatric
visits, it became clear to me that maybe this dynamic was being shaped without
even the child, family or doctor being aware of the development. Through
thoughtful and meaningful interaction over a period of time, the pediatrician
could become a trusted presence in a child’s life such that the cultivation of
positive well-being and the adoption of self care practices could actually
develop. We all want to be happy, healthy and at peace with our true nature.
Sometime illness, negative thoughts, and unexpected life events can cause
upheaval in this balance. While I always want to know that I have people in my
life that I can turn to when times are difficult, I ultimately want to know
that I have the tools and personal resiliency to face any challenges, all the
while with my support team waiting in the wings to catch me should I stumble.
Being a pediatrician can be so much
more than simply being the kid doctor. As physicians of adult patients, it can
be rather difficult to see where we fit into the patient’s idea of wellness and
day to day self-care practice. Often we get derailed by discontinuity or lack
of communication/connection with our older patients, yet this is not an excuse.
A recent Ideas and Opinions piece
from the May 19th, 2015 issue of Annals of Internal Medicine entitled “Balloon Animals, Guitars, and
Fewer Blood Draws: Applying Strategies From Pediatrics to the Treatment of
Hospitalized Adults” sought to showcase how we can improve care in the hospital
for adult patients by utilizing a pediatric approach. While the article was
creatively original as well as practically relevant to our current health care
system, it got me to thinking: “What if we combined the pediatric approach with
the holistic model of personal well-being and applied this in the outpatient,
functional environment, away from the hospital? As I have said many times
before, the hospital is all too often the home of sick care while true
preventative holistic medicine conducted at the home is healthcare, so why not
spend more energy changing the way we care for adult patients outside the home,
than continuing to reform and revamp an institution that routinely fails to
provide health and vitality to the majority of people seeking aid. I am never
one to discredit the value of hospitals, and certainly do not want to come
across as someone who views the thoughtful Annals article as misguided, I
merely want to suggest an alternative use of our time, energy and resources.
Sure, my kind of hospital would look a lot like the one described by Michael R.
O'Brien, MD; Marjorie S. Rosenthal, MD, MPH; Kumar Dharmarajan, MD, MBA; and
Harlan M. Krumholz, MD, SM, but I also see something more, a new frontier for
medicine, a replacement for the hospital when one needs just a little more care
than what is realistically achievable while living strictly at home. Just
maybe, with the help of a few friends and many years of hard work, we might
just see the creation of a new healing institution that truly embodies what it
means to provide Healthcare.
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