Archive for July 2010

Monthly Archive

A Divide Between Doctor And Patient: Protocol

There are things we (the providers) do to health care that are hurtful. We make protocols and rules that divide us from our patients. Protocols that sometimes make patients feel alone, distant, and disconnected from their doctors. I don’t mean algorithms of care (safe, standardized ways of how and why to treat pneumonia, for example), I mean clinic rules for helping patients schedule and get in to see doctors appropriately. Triage pathways, if you will.

I hear about these protocol-type irritations from patients all the time. Because I’m a part-time practicing pediatrician, it’s often hard for families to see me when they want. Yesterday, a patient informed me about calling one time while in route to her daughter’s appointment. She had been at a trauma hospital with a family member who was receiving care for a life-threatening condition. She was trying to make it on time to the appointment, but wanted me to know she’d be a few minutes late. She called the clinic and the receptionist said, “No, Doctor Swanson won’t see you.” Of course, this is untrue on some level. In her state of stress, I would always love to make allowances. I work in clinic to help families, precisely when life is upside down. But because of a script and protocol, she was pushed away. Of course, if we saw everyone who arrived late, we’d never be on time or reliable, ultimately rendering us less useful. Protocols do make sense. But they don’t take outliers (life) or individual patients into account.

Many things clinics do in efforts to improve care for all, hurt individuals. The utilitarian-like clinic doctrines I tend to hate. I think of these protocols as walls. Tall structures built up to protect us all from the abuse that only a few people will commit. On occasion, these walls break down the relationship that exists between doctors and patients. Read full post »

“Guns In Your House?”

Asking friends about guns is like asking about their underwear. Not in the pediatric office, but at home, on the street, and in the neighborhood. Hear me out…

My next-door-neighbor (NDN) is a stay at home dad (SAHD). On most days, he runs his household and wrangles 8 and 6 year-old boys until his wife joins him after work. The three (or four) of them seem to weave and pedal through life, on and off their bikes. I can see them coming and going throughout the day; it’s my crystal ball of sorts as to what life with 2 boys may look like about 5 years from now…

Last Friday, NDN approached me from his porch. We often talk, porch-to-porch, about life, the trees, our favorite noodle shop, or the weather. Last Friday, it was different. He said, “You should write a post about gun violence.” I said, “Yah, I know, I should write about 2 million posts…”

But then he framed the issue for me. And I knew he was right.
Read full post »

A Sunday Drive

Out for a Sunday drive. Just two little boys and the open road…

“Eeeeee” My New Favorite Syllable

O has added some syllables to his vocabulary over the last 10 days. And they are simply delightful. Precious, really.

Warning: this post sounds like it’s written by his mom.

O has been embellishing his sentences with a little “eeeee” at the end of words. The Popsicle is now “cold-eeee” when he grabs it. The stove is “hot-eeee.” And when “Momm-eee” and “Dad-eee” walk in the door, it’s, “Hi-eeee!”

I love it. The error, the innocence, and the experimenting. It’s as if he’s trying English on and adding accessories. A belt here, an extra bracelet there. He’s learning how to use his language rather than just repeat it and mix it up. When people say, “Gosh O looks like you,” or “O looks just like _____,” I usually say, “To me, he looks like O.” Because that’s how I see it. But now he sounds like O, too. A pattern and change that are all his own. Just like when F used to say, “kokay.”

It’s one of those delectable little things your toddler says in error that you hold on to for dear life. I know that like grasping at time or holding onto air, it’s senseless. Too soon, the “eeeee” is going to vanish. So for now, I’m holding on as tightly as I can while trapeeeeezing through time.

Drowning: Quieter, Faster, & Closer Than You Think

Two teenagers died in New York yesterday. Not from a gun shot, a car crash, or suicides. Rather, they drowned in a popular swimming hole in the Bronx river on a hot summer day. I hate stories like that. Hate hearing it, hate seeing the headline. A total failure for prevention efforts.

I talk about drowning in clinic every day I see patients. I should probably talk about it more often. As I said in my earlier post outlining the new AAP Prevention of Drowning guidelines (& swimming lessons between age 1-4 yrs), drowning is the second leading cause of injury related death in children 1 to 19 years of age. And most drownings in the US happen this time of year. When it’s hot outside, the lake, stream, or pool can look really gooood. Even to those who don’t know how to swim.

I talk about drowning mostly with the parents of toddlers. But I should spend more time talking with adolescents. I get distracted by all the drugs, sex, and rock-and-roll stuff I talk about. Today, I am reminded of the importance of talking with teens about drowning, because of those teens but also this perspective about drowning.

See drowning isn’t what you think it is. It’s not loud and splashy and outrageous. It’s not like it looks in the movies… Read full post »

The Working Mom Wonders, “What Am I Doing?”

I’ve been caught in a recurring cloud this week even though the sky has been essentially spotless. It’s been one of those weeks where I find myself spinning around to grab the cup of milk or the steering wheel, muttering, “What am I doing?”

I am back perseverating on how to do this right. Life, I mean.

The issue of balance between work and parenting while trying to contribute to the world and use my skills (read: loaded issue) bubbles up at times. I never quite know what will trip me up, triggering a re-evaluation. But it comes up. Quarterly, let’s say, like state taxes…

There are days I am astonished by my opportunities and the children I get to take care of. And days where I am so delighted by my kids, I cry when I leave for work. And days I question if I have the stamina to endure. Last night by the end of clinic, I was so tired and my eyes so bloodshot (no idea why), that my medical assistant took my temperature. It was normal. But, point is, it happens; I do get really tired.

The real trouble is this: I liked my day in clinic yesterday and the things I discovered: the broken bone I found in a 2 week old, the teenager I helped with depression, the 20+ check ups I completed. But tired and missing my boys, yes. See, this would be far easier if I was only pulled in one direction. It’s not how it works for me; I have tugs on each limb. Read full post »

Verbatim: Does My Child Need Vitamins?

Every single day in clinic a parent asks me, “Do I need to give my child a multivitamin?

The short answer: No. The long answer is, of course, more complicated and evolving.

There is no research that finds young children, even the “pickiest” eaters out there, need a daily supplemental multivitamin. But there’s one sneaky little exception: Vitamin D. Over the past 5-10 years there is mounting evidence demonstrating that the majority of children in the US have low vitamin D levels. Children lack both the dietary intake of vitamin D and the exposure to UVB light from the sun they need. My blog posts explaining Vitamin D supplements in infants and children go into more detail.

All infants and children need 400 IU of Vitamin D every day but not a whole multivitamin. You can usually get 400 IU from a multivitamin (read the label), but also just as easily from an isolated vita D supplement.

So, you really may be able to bid Fred Flintstone farewell…

Less Is More: 4 Ways To Know

I keep saying less is more. So often, with children, the less we do, the better. Pediatricians often pride themselves on being smart enough to know when to do…..nothing.

Take pink eye, for example. You know, the gnarly ooey-gooey, eyes-sealed-shut-yellow-crusty-”sleep”- in-the-eye that never goes away? The highly contagious infection where your child looks uber-crummy and straight-up, infectious? When it happens, you create a self-imposed lock-down-blinds-drawn-cancel-all-plans-covert-stay-home and watch a movie to hole-up the contagion. You or your child may want to hide from the world until it improves.

In my practice, pinkeye is one of the those infections that inspires me to wash my hands over and over and over again.  It is really contagious. And the best thing you can do when you see a glimpse of it, anywhere, is wash.your.hands.

So you haul in to see your pediatrician. Question is, what does your doc do for your child? School is asking for a note to come back and you’re there for a quick-fix thinking, “Just give me something to make this go away. And fast.” And like always, it depends on a number of things. Read full post »

Eat Your Veggies, Create A Rooster Tail At 74

This is my Father-in-Law. He’s turning 75 this year. He’s a smart, earnest man. I learn from him every time I have the luxury to see him. It’s not just the little things he says, the wisdom he imparts, the places and spaces we disagree, or  the way he parents the husband. More, it’s the way he lives his life.

I was in the back of the boat last week while he skied around a deep lake in Wisconsin. Picture me, snapping photos, jaw dropped way open. Mosquitoes stuck between my central incisors. We were attending a family reunion, an 80th birthday party, and had a whole week with the boys. More on that later, but let me just summarize the time with them (except for one afternoon): yum. During this whimsical boat ride, and after the jaw drop, I had a cartoon-ish grin on my face. I mean, this is kind of awesome, yes?

The trip really made me think he’s figured something out. Yesterday in clinic I was loaded down with check ups (count them: 20+), which often translates to lots of time talking about overweight. Read full post »

Silent Deliciousness

When I first watched this video, the computer volume was off (I didn’t know it) and I thought this was a silent video. I loved the stillness of the quiet mixed with the emotion of the ad.

I cried (yes, I’m the kind of person who always does) one of those quiet cries, the kind where you’d never know I was crying unless you were looking straight into my eyes. Tears just dripped silently.

Instead of being impregnated with fear, this public service announcement is loaded with hope.

Such a simple, kind way to illustrate why we take the time to buckle-up.

Isn’t it amazing how much people love you?

PS–Because it was such a stunningly nice way to watch this, I recommend you watch this first without sound, then watch it again with the music turned way up. Also, if you share this with teens, will you share with me what they thought of it? I’m on the fence thinking this will resonate with those 12-18 year olds. As I am in the process of creating a list of videos for children to watch on YouTube (to hand out at check-ups), I wonder if I should include this. Digame.