Ten reasons this primary care pediatrician is thankful to her patients and families

1. Thank you for asking me questions, listening to my answers, discussing options together.

And for answering the many questions I ask of you.

2. Thank you for brushing your teeth in the mornings.

And in the evenings.

3. Thank you parents, for letting your teens talk with me in private.

I always encourage them to share with you what we discuss.

4. Thank you for asking for refills before your medications run out.

And for using your inhalers with spacers.

5. Thank you for understanding how important vaccinations are for your children.

And for getting your own influenza and pertussis vaccines, as parents.

6. Thank you for modeling healthy behaviors.

Reading, drinking water, minimizing inattentive screen time, and getting exercise every day. Together.

7. Thank you for letting medical students and residents learn pediatrics.

You are their teachers too.

8. Thank you for working on quitting smoking.

Call 1 800 QUIT NOW.

9. Thank you mothers, fathers, aunts, uncles, grandparents, great grandparents, neighbors, and cousins for caring about the children you bring to the pediatrician.
It takes a village.

10. Thank you for sharing your stories, and inspiring me to grow and learn with you.  So we can all be as healthy as possible on this journey.  
I'm listening. 


(an earlier version was posted previously by me at www.pediatriccareer.org and I'm still thankful)

If you're a mother, you've done a lot of research

You're drawing on the literature, you're weighing the risks and benefits of various protocols of parenting, and you're conducting the all important experiment called being a mom, confirming hypotheses and identifying new areas of uncharted territory for exploration.  I'm co-parenting a middle schooler presently, so you can imagine that the data is incredibly hard to interpret.  And the participant has many questions about the plan.

And then there are the other people in my life, the medical students.  They have a lot of (great) questions too.  One thing that many medical students universally ask is why, whether or not, and if so how should they do research in medical school.

This weekend I was at the American Academy of Pediatrics national conference (a local national conference, and so I shall at some point post about the ups and downs of big annual conferences that happen to be in one's own home town).  Before a packed house of medical students from around the country and the world, I served on a panel where we were asked question after question about preparing for residency.   

In the ramp up to the panel, the AAP's young peds network launched a new forum for tackling these kinds of questions and I was asked to write about research during medical school.

• Why is research looked upon favorably by residency programs?  (Is it?)
• Why would it be a good thing to gain research experience? 
• How do you go about getting started?   

Should you get involved in research on the way to residency?  For my take on these questions, see Research for Residency here.  Bottom line, whether you are in middle school or medical school, it's great to search for answers, to delve into a given topic and set about to gain a systematic understanding.  Especially if you are enriching yourself and serving others.

Season finale of “As the Residency Turns”

* DISCLAIMER: I meant to post this back in June as I finished residency but it got put aside as I filled out my umpteenth credentialing application. Here it is now. I wrote it 2 days before finishing my last primary care rotation of residency:

After 3 years of residency I have had some amazing interactions with patients. Amazing in the wonderful way the 9 month old whose well child checks you have always performed smiles and babbles when you walk in way and reaches out for you to hold her. Your heart opens wide, the parents are at ease and you think to yourself, “yeah, this is why I do this!” Or amazing in the way things go when a developmental delay I picked up is being addressed by Early Intervention and we can all see how the affected child is flourishing. Or when you talk that sexually active teen into being more assertive in communication with partners and you get her to get a Nexplanon.

Then I have had some intense interactions of the other kind. Intense in the I was so concerned that I called Child Protective Services and now a CPS worker is here with you and you are yelling at me and I am crying and I want to work with you so much but you hate me right now and won’t listen to anything I have to say kind of way. Intense in the way things go when a parent has what appears to be bipolar disorder and splits on providers and one minute says our hospital saved his/her child’s life and the next is cursing about how several of our providers did them wrong.

During the amazing ones, my heart soars, during the intense ones my heart plummets and I often get palpitations. I have been having a few day run of extreme highs and pitiful lows. I have 2 more days in clinic before my last day of residency at the end of June and there are so many loose ends. I realize that clinic is the only part of residency that resembles continuity; we do other rotations for a month at a time and are essentially visitors but in clinic you are like the cousin who comes home regularly for major holidays and family gatherings.  The end is in sight and I feel like I need some closure - so much so that I helped draft a letter to our patients from the graduating seniors updating our patients on where we would be going and now parents come in and say “Dr. Bee - you’re really leaving us?!?”.

There are so many amazing patients who will continue to grow and I will miss their new developments. And I have a few difficult patients who once I’m gone will literally have no one else who wants to work with them. 2 more days. What can and will I do? Why does it feel like such a huge deal? I think I’m scared and sad that things are coming to an end, it’s for the best, right? Why do I feel like a success and a failure all at the same time?

That way you talk

I was in the office speaking with a parent and her kids at some point in the past year (how's that for sufficiently anonymized).  The mother was gazing at me for just a little too long.  She could have been pondering my most recent question, or may have been lost in thought, but at that moment I opted to ask her gently if she was okay.  And she simply said, "I'm sorry, I just love the way that you talk with my kids."

Oh how that made me feel that I'm right where I should be and doing what I should be doing.  She saw the way I really ask, really listen, and aim to motivate. It's working, at least in this case. 

You've probably heard similar positive comments from time to time about how you communicate with your patients.  And yet, if I could only do so at home!  I can be ever so calm and motivating, building partnerships, and serving as a measured and informed voice of reason at work.  And while I want to consistently do the same at home, I CAN'T HELP YELLING. AT MY KIDS. SOMETIMES. GOT TO WORK ON THAT.  You?

What's your idea of fun?

Our health centers are “medical homes” now, so I have to come to accept (but not necessarily embrace) my allotted turn or assignment to work, i.e. see pediatric patients, on an occasional Saturday. Periodically, I am able to trade these away, so they end up being few and far between. After a full day of patient care on a recent Saturday on a recent 3-day holiday weekend, my family (me included) were out to dinner and a colleague happened to be picking up dinner at the restaurant where we were dining. She came over to make small talk, and I mentioned I'd just come from working the whole day.

My young son then chimes in with, “But mom, for you, work is fun, so it’s not so bad.”

And that got me thinking about whether or not it is fun. Of course, there are all kinds of fun. Family fun is our recent amusement/water park trip, swimming in any lake, ocean, or gorge together, and family movie night. My individual "fun" is going on a long run, doing the Sunday NY Times crossword puzzle, or simply sleeping late.

But the perception that work is fun has got me thinking. Indeed, a lot of pediatrics and teaching is, when my patients giggle and the toddlers talk and my students are inspired and inspiring. And my work is gratifying. It feels meaningful. But at times it is heart-wrenching. I’m intrigued that “fun” is how I portray my work to my children, or that this is how they perceive my orientation towards what takes me from them day to day. That this one word (fun) has encapsulated their mom’s chosen career path.

Say What?!? Time to find a job!

It’s that time of the year. Career preparation time. I am applying for community pediatric jobs in the D-M-V (Washington DC-Virginia-Maryland) area and it feels surreal. Medical school in the area was extremely enjoyable and our family hopes to return and lay some roots (is it weird to really want to be on House Hunters?!?).

What didn’t happen:
- I didn’t get Chief Resident. I was pretty bummed out for several weeks, but I think it’s for the best. My mentors reminded me that I pretty much have all of the skills I would have been able to obtain (leadership, administrative) and if I am totally honest with myself acting as an Inpatient Attending for several weeks and crazy hours is not my cup-of-tea! I’m all about outpatient medicine and am ready to have regular hours, my own patients, and more time with my family. No pseudo-residency-with- poor pay increase for me.

What has happened:
- started talking to my Academic Advisors about my interests in community pediatrics
- had a few outstanding people offer to serve as references (Clinic Director, Chair of our Peds Heme-Onc Department, Mentor, etc . . .)
- written and revised my cover letter
- written and revised my Curriculum Vitae (CV)
- gotten considerable feedback from my Clinic Director, Academic Advisor, family and friends including an amazing sorority sister who's a Lawyer who cut my cover letter up so much that I basically rewrote it and it's soo much better
- started regularly visiting the PracticeLink and Pedsjobs websites
- registered for the AAP National Conference in San Diego in October

What I still have to do:
- finish reading “Lean In” (loving this book, so enlightening and inspiring. I’m all about leaning in!)
- send out my cover letter and CV to personal contacts in the area letting them know I’m ready to “discuss employment opportunities” (loving the sound of that)
- actually find some jobs to apply to
- go to the AAP Conference’s career fair and professional development sessions and dazzle some program/practice reps and learn about interviewing and contracts
- finish the last 11 months of residency
- start work as a Pediatric Attending Physician (woo-hoo!)

Alright practicing physicians - any suggestions? Anything you see missing in my list above? In applying for jobs after Residency what mistakes did you make? What do you wish you’d done differently?

Nicely done?

Went to the pediatrician with my daughter for routine primary care visit.  I thought she (the pediatrician) did such a good job with my daughter in terms of the tenor and content of the discussion, the calm demeanor, the subtle but savvy questions, the listening, and the encouragement.  Promoting wellness, self -esteem, and balance.

Later in the evening, reflecting back on the visit (and talking with my spouse) I realized how similar the pediatrician’s approach seemed to my own approach with my tween patients.  Or at least was what I aim to do.  But then I wondered about how circular this is.  I like the pediatrician because she practices like I do. How self-congratulatory is that?  And yet, perhaps instead it's that she and I are similarly mediocre pediatricians. Regardless, my daughter stated after the visit that her pediatrician was the “best pediatrician ever.” (Present company excluded, of course.)  

Do you learn about doctoring when, as a MiM, you go to the doctors?  I have tried to over the years. And as a MiME (Mother in Medical Education), I teach some stuff too. Actually, we chose this pediatrician in part because she trained with us.  More circularity.  Nicely done!

Membership

When I arrived at my office this morning, I had a walk-in patient waiting for me. In the winter months, it’s not unusual for a parent to try to “jump the line” and want to be seen first thing, and I try my best to accommodate parent and patient. I had promised to do a medicine re-check for my nurse’s child after I made morning hospital rounds today so that we could get her child to school, and my nurse back to work. My partner saw the walk-in who had stalked Lori, my scheduler, at the back door forty-five minutes prior to my arrival, while I saw my scheduled re-check.

Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.

Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.

The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.