As we move through our lives and progress through their various stages, we sometimes forget what got us to where we were going. We often move the training, learning, and experiences that shaped us to the back of our minds as we live in the moment and look toward the future. It is not that we don’t appreciate what we went through, but we move on.
Ordering blood chemistry panels, complete blood cell counts, cultures from various sites in the body, radiologic studies, and other examinations to provide data is commonplace during almost every medical encounter and investigation. However, obtaining this data can be a double-edged sword.
While a ship and a hospital are two very different settings, the common denominator is people.
People are people and they pretty much respond to similar things in any work environment.
The lessons that I learned from the director of hospitality on a vacation vessel are lessons that can be applied to a medical team as well. While there are other variables in the medical system that may need to be considered, the lessons of building a supportive, respectful, diverse, and celebratory culture aboard a cruise ship, where staff maintain unwavering enthusiasm and friendliness despite the daily grind, serve as a remarkable blueprint that transcends industries.
What, may you ask, is more important than advocating for the health and well-being of others? It is the health and well-being of you. There is a saying that you should “put on your own oxygen mask before helping others put on theirs.” It is a cliché, but nevertheless very true in medicine. Physicians tend to take better care of others than they do themselves. So, how do we flip the script?
Many primary care pediatricians may only see a few cases of rare diseases in their training at specialized children’s hospitals and much less frequently when they go into practice in the community. So, while physicians are trained to identify a wide spectrum of diseases and illnesses from the very rare to the most common, the nagging voice in the back of our minds speaks to our paranoia and fear of missing the most serious and rare diseases. Recognizing rare pediatric diseases is often like finding a needle in a haystack of common ailments and a healthy dose of vigilance with a high level of clinical suspicion is often required to identify the subtle signs that can make all the difference in a child’s life.
As I sat with a family who decided to terminally extubate their critically ill child, I couldn’t be overwhelmed by the sadness because it wasn’t about me. As I watched the emergency team perform cardiopulmonary resuscitation on an infant with no return of electrical activity of the heart, I couldn’t be flooded by the pain because it wasn’t about me. As I have witnessed too many unfortunate events of the death of a child, I couldn’t be paralyzed by the gravity and finality of the situation because it wasn’t about me. How do we grieve during the intimate experience of witnessing the death of a relative stranger while feeling that it is not our place to partake in the sadness of the moment?
A recent article published in Pediatrics, the American Academy of Pediatrics journal, described characteristics of fatal poisonings among infants and young children in the United States. They identified 731 deaths from poisonings for children 5 years of age or less during the time period from 2005 to 2018 in a national poisoning registry. The piece of data that stood out for me was not the fact that opioids were the leading cause of death from poisonings, but that over-the-counter pain, cold, and allergy medications were the second leading cause of death from poisonings in this age group.
There is no shortage of billboards, radio spots, and television commercials that tout the benefits and accolades of hospitals to encourage patients to choose them for their care. There are hospital rankings in national magazines, individual evaluations on online review sites, testimonials, and patient personal interest stories to showcase a hospital’s clinical and institutional prowess. But, I would argue that these public relations techniques are not the most effective or authentic methods for building ultimate trust or influence in a community.
By getting vaccinated, individuals are not only protecting themselves but also contributing to the greater good of society. Vaccination is a social responsibility, and it is important for individuals to understand that their decision to get vaccinated can have a significant impact on the health of their community. The public good is about creating a fair and just society that promotes the well-being of all its members and ensures that everyone has the opportunity to thrive. It requires collective action and a shared commitment to the common good.
Have you ever wondered why some projects succeed and others fail? A strong indicator of the success or failure of any project or task is the involvement of someone who is dedicated and willing to be ultimately accountable: a champion.
After taking a hot yoga class, I was recovering in the lobby…sitting on one of the risers trying to catch my breath and rehydrate. As I was sitting there, I noticed that the yoga instructor who just taught the class was engaged with the manager in a discussion just within earshot of my position. She was a new teacher and this exchange appeared to be a checking-in point. Little did I know, I was going to be a fly on the wall, witnessing a masterful display of leadership.
We all have times when we feel stuck in our creative process, whether it be writing, painting, drawing, building, or other actions of creating anything. Some may define this feeling as writer’s block, a creative slump, an artistic freeze, or an inspiration drought. Whatever the name, the result is the same. We feel stuck and don’t feel we can create anything. So, how do we move past this feeling of having a pause in our creative process?
Under the proper guidance of healthcare professionals, ChatGPT (and artificial intelligence programs like it) is a tool that can produce content for teaching and education with a degree of efficiency that is unprecedented. Also, if used and curated correctly, the healthcare industry has a powerful ally that can aid in producing volumes of content to combat the infodemic and dispel medical misinformation. But, there are limitations.
We all make decisions about whether something is worth the price it takes to attain it. That “something” is not necessarily an object. That “something” can be success defined by advancements or accomplishments in your job, outshining the competition in a sport, excelling at a particular hobby, being the best parent, or any number of other activities, actions, or projects. There is some price to pay for doing what you want to do and how well you want to do it.
There are times when in-person physical exams, labs, and studies are required. The expectation of receiving antibiotics for a sore throat or ear pain, a return-to-sports note after a head injury/concussion, or differentiating a sprain from a fracture are issues that are best left to in-person evaluations. Even with that said, telemedicine is amazing and there is a definite role for it in healthcare. But, by understanding the limitations of telemedicine encounters, expectations about what can actually be cared for at these visits and what should be deferred to in-person evaluation can be managed appropriately.
I think that every business owner can empathize with the feeling of trepidation that is experienced with every Yelp review email notification. Good or bad reviews notify the business owner identically when they arrive in the email inbox. There is no differentiation between the ping notifications. You have to open the email to see the positive or negative responses.
However, sometimes, a crack in our armor is found that allows a comment from a patient, the look of a parent of a child in our care, or an identified medical error to penetrate our armor to ignite the flame of insecurity that spreads throughout our soul like wildfire. It is at that time which we find ourselves facing our worst enemy.
Damar’s sudden cardiac arrest and recovery emphasize the importance of the recognition of sudden cardiac arrest and prompt CPR with the use of an AED. The rapid recognition of his symptoms, the institution of CPR, and the use of an AED saved his life. Because of his ailment and the widespread coverage of it, the public has learned more about sudden cardiac arrest and its management.
When science is rejected, we lose footing on understanding nature around us and ourselves. From a healthcare standpoint, we become less fit for survival and lose the opportunity to evolve and fight those elements or conditions that would reduce the quality and length of our lives.
There are a number of variations on the saying and many authors to whom it has been attributed, but the consensus is to “never try to be the smartest person in the room”. This is particularly important to consider when you are in a position of leadership.
We’ve been hearing a lot about long wait times in emergency rooms, clinics, and urgent cares across the country. And, we have yet to fully enter the winter season which is traditionally worse, when it comes to respiratory illnesses…especially in children. So, why have we had such long wait times?
Change is a single constant. Oftentimes, with change, there can be much uncertainty about potential outcomes. Uncertainty is uncomfortable and usually precipitated by incomplete information, unknown effects or consequences, and limited knowledge. And yet, the last few years have shown us how opportunity loves uncertainty.
The goal of making a hospital pediatric program a greater presence in the community hinges upon two areas, building community and alliance with local pediatricians and creating more visibility in the public arena. Both are not mutually exclusive, and each affects the other. The goal is to create a positive experience for both areas that will enhance each individually as they connect with one another.
Leadership is not easy and finding true leaders is frequently challenging.
All too often, one is placed in a position of leadership and acts as a manager and not a true leader. True leaders exhibit characteristics that position them to not just make sure that tasks are completed but to create a culture around task completion that provides mutual caring, collaboration, belonging, enthusiasm, and many other positive modifiers that denote a high-functioning team. The high-functioning team will outperform and outlast those that are devoid of the culture created by a true leader. It is always said that most leaders manage rather than truly lead. There are 6 traits that separate a true leader from a manager or poor leader.
Reflecting upon some curiosities in medicine, my mind wandered to how humans fear illnesses and diseases that they can see with their own eyes more than those maladies that they can’t see. Of course, there are exceptions, but I have generally noticed that people respond differently to visible and invisible maladies. What is it about the things that we can see versus those we can’t?
Many medical terms are thrown around in pediatrics, and some terms are confusing. There can even be differences in the definition of medical vocabulary between medical personnel and the public. This does not mean that either party is wrong. It just means that there is an opportunity for miscommunication because the interpretation of the medical terminology may be misconstrued.
The huge amount of appreciation that I felt was for the professionals whom I shared the experience with and it showed me how important it was to have the support of others when stepping outside of one’s comfort zone. I may have felt alone initially, but I soon realized that I wasn’t!
The concept of the unknown brings up different feelings in different people. The uncertainty that accompanies the unknown can be a source of great anxiety and fear. However, it can also be the motivation for curiosity and exploration. The decision to choose one path or the other depends upon a person’s perspective.
Sometimes you say things that you wish you could take back. I experienced that feeling as a new attending physician a number of years ago. I was rounding on patients in the pediatric ICU and came to the bedside of a child with a mother who was upset with the care that was being delivered and the plight of her child. I stepped forward to comfort her and the words, “I know how you feel”, escaped my mouth. I would immediately regret my statement.
Having been in the field of pediatrics for a few years myself, I thought that I would pass along some unsolicited advice to aspiring pediatric interns. There is no shortage of advice on how to succeed in various specialties. But, I thought to myself…what were some things that you could do to guarantee your failure in a specialty such as pediatrics?
Images from medical television dramas often show an adult grasping their chest in pain and surprise as they experience a heart attack. However, not all chest pain presents like that. Also, not all chest pain occurs in adults. Kids can experience chest pain as well. This article explains chest pain in children from the perspective of a pediatrician.
There are a lot of other things that I could do with my time. What do I get out of writing and why has it become so important to me? I have been contemplating these questions recently and decided to write an article about why I write.
August is National Immunization Awareness Month. The American Academy of Pediatrics recently posted a news piece on the disturbing state of affairs for childhood vaccines due to the pandemic and urged parents to make sure their children’s routine vaccines were up to date, along with their vaccination against COVID-19. The resurgence of vaccine-preventable diseases is a real concern. The reason for the drop in vaccinations among children is likely multifactorial.
Hospitals, clinics, individual practitioners, and other types of medical groups strive to create the best practice or program in their area of medicine. These best practices or programs are usually defined by metrics such as satisfaction with care, financial remuneration, as well as the consistency, effectiveness, and efficiency of medical care. The bottom line is that any practice or program aspires to have the best outcome, as defined by the metric of their choosing. But, how does one achieve this lofty goal?
While the practice of medicine is more than just medications, supplies, and diagnostic tests, these elements are critical to performing the best and most current standards of care in medicine. Resource limitations can change medical practice, like any other business or service industry. So, while a noodle shop can still serve plain soup if they run out of noodles, the dining experience is just not the same.
Isn’t all medicine based on evidence? While most would prefer that to be the case, medicine is as much an art as a science sometimes. Our understanding of medicine is still growing and that growth occurs through the accumulation of scientific evidence.
We have all heard the saying “beauty is in the eye of the beholder.” Abraham Lincoln once said, “Most folks are about as happy as they make their minds up to be.” Thinking about these quotes, I find them applicable to the concept of success in medicine. My adaptation would be that “success in medicine is in the mind of the participant” and that “most physicians are about as successful as they make their minds up to be.”
The unusual ways in which children can present with symptoms of an illness or respond to medications is really a lesson in expecting the unexpected and trial and error of treatment. One has to keep a high index of suspicion for particular disease presentations by knowing the broad array of symptoms and understanding that kids may not present with stereotypical symptoms. Furthermore, a treatment that works for one child may not work for another and the same treatment that worked in a child may not work in that same child at a later date. So, while we expect kids to act and respond in the ways that we anticipate in pediatrics, they don’t always “read the textbook” and we just have to reassess and adjust.
Dr. Google does hold significant authority and prestige in the community and may be more revered than most non-digital medical providers by the public. So it goes without saying that clinicians may be intimidated by this medical authority. How should the medical community deal with this medical provider that has never actually examined a patient or engaged in discussions during a medical encounter?
If you haven’t met with resistance, harassment, or negative comments on social media while communicating medically accurate information and dispelling inaccurate medical information, you haven’t been advocating hard enough or stepping into arenas that require the most attention.
I understand that medical institutions and organizations have their reputations to protect. But if an individual is willing to put their reputation and safety on the line for the good of society, they should be supported by their medical institution or organization.
The language of medicine can be confusing and uninterpretable to those not immersed in the world of medicine. There is a lexicon of technical terminology, acronyms and abbreviations, words that are known and are used differently in the medical arena, and other classifications of medical jargon.
I have a daughter. She is faced with the knowledge that her rights have been affected because of her gender. While one could argue that the ruling was not intended to discriminate against women, one would overlook the fact that only women can become pregnant at this time (for those who are able to get pregnant). So, how could one not conclude that this decision that affects the right to self-determination is not gender-based bias?
We are all human and are subject to the same array of emotions and mental constructs that manifest when a loved one has a health concern. Once we understand that, we may be less inclined to label anyone “difficult” when conflict arises, especially parents.
In the US, July 4th is celebrated with fireworks and barbecues. Also, the summer sun is at its peak intensity. So, there is a higher risk of burns, heatstroke, heat exhaustion, and dehydration. Understanding these heat-related injuries and illnesses is essential to better prevent them from occurring, especially in the pediatric population.
As the weather warms up and kids run to the pools, drownings are a significant concern among pediatricians and other medical professionals who care for children. I acknowledge that there may be some confusion about various aspects of drownings. The basic pathophysiology of drownings is important to understand, so that there is more clarity about some misunderstandings that circulate during this time of year. Common misunderstandings include the idea of dry drownings and secondary or delayed drownings.
I see some truth reflected in TV medical dramas about medicine. So, what can TV medical dramas teach you about being a doctor?
This is the fifth part in a series about when parents should seek medical care for their children, from the perspective of a pediatrician.
When I think of the image created by John William Waterhouse, it is no wonder why the painting is referenced so often in medical futility presentations. It so accurately reflects the model of futility with medical treatments in some situations and really highlights the concept that we often confront in medicine…“Just because we can do something…should we?”
This is the fourth part in a series about when parents should seek medical care for their children, from the perspective of a pediatrician.
Yesterday, a gunman killed 19 children at an elementary school in Uvalde, Texas. I have no words to express my condolences to the families who lost children to this atrocity. I have no words to express my inability to understand why this is just the latest in a string of school shootings, not to minimize the non-school, mass shootings that occurred in other locations in the US as well. I have no words to express my concern and sadness over this senseless loss of life. I have no words to express my feelings any more eloquently than anyone else who has commented on this incomprehensible event that is yet another dark day in our nation’s history.
The main danger is families trying to create their own formula or formula replacement and trying to extend their formula supply by diluting the formula with more water to create a larger volume of formula.
"Know what you don't know" is a common saying that I have used throughout my career as a pediatrician, with trainees in medicine. It seems to be the best piece of advice that I have been given and the most important teaching point that I’ve passed along to others. However, I have only just begun to realize how important the phrase is in all areas of life and not just in medicine.
This is the third part in a series about when parents should seek medical care for their children, from the perspective of a pediatrician.
When I went into medicine, I had no idea that I would become a teacher. I don’t have the credentials of a teacher. I never went to school to learn how to be a teacher. But, nonetheless, here I am…a teacher and a pediatrician.
This is the second part in a series about when parents should seek medical care for their children, from the perspective of a pediatrician.
As the dayshift readies itself to leave and the nightshift gets ready to take over, one can see groups of physicians, nurses, respiratory therapists, and other staff talking intensely with each other to hand over care to the next team. Settling in and focusing on my colleagues’ voices, the stories regarding 20 children in the CTICU are relayed to give me enough information to take care of them through the night.
Throughout the pandemic, there has been so much controversy about masking and distancing. I’m not an infectious disease specialist, epidemiologist, or even a public health researcher. I’m just a pediatrician. But, I feel like most pediatricians are like “canaries in the coal mine.” We see respiratory infections on the front lines before the research numbers come out. And we have seen the effects of masking and distancing firsthand in the healthcare setting.
This is the first part in a series about when parents should seek medical care for their children, from the perspective of a pediatrician.
Why should doctors become involved in social media? As a pediatrician, I asked myself this same question a few years ago. My answer was, “I don’t know.” But, then, I thought about it more and its importance in the current environment of healthcare.
Symptoms of a “cold” or a viral upper respiratory tract infection can occur repeatedly and persist for quite a while, making it seem that your child has been sick for months at a time. This healthcare editorial discussed the viral upper respiratory tract infections that children experience during the pandemic and non-pandemic times from the perspective of a pediatrician.
It is true that children, for the most part, do not get as sick from COVID-19. Nevertheless, while they are at low risk, they are not at no risk for severe disease or even death from COVID-19. The vaccine is an important healthcare intervention for children and its importance is presented from the perspective of a pediatrician.
As a pediatrician, I have seen children on life-support with influenza and children die from influenza. There is one statement from parents that I still find baffling: “We don’t get the flu vaccine.” The flu vaccine is an important part of healthcare preventative measures.
As a pediatrician, I found that work–life balance in healthcare takes a concerted effort and work, not only in one’s personal life but also in one’s work life. Furthermore, work–life balance requires looking at oneself, critically, while assessing one’s life priorities, shedding perceptions/expectations, and giving oneself permission to seek balance and live a balanced life.