My first transgender patient was a teenager who said although he was born female, he’d protested his gender from the time he could talk. He told a story of being asked, “Well, if you are a boy, where is your penis?” and he pointed to his umbilicus (which was an “outie”). OK, no problem, we have a gender clinic I can refer you to.
When he came back and asked for …
A physician is worried about gender transition in pediatrics
In his article, “Medical education needs to stop burning out students — now,” Augustine Choi suggests the culture of medical education is responsible for increasing numbers of depression and burnout among medical students, and suggests that more programs are needed to address self-care and wellness in order to build resilience.
While I agree that mental health treatment should be readily available and easily accessible to those in …
To extinguish burnout, bring back physician autonomy
Imagine your typical yearly physical. It’s probably booked for 20 to 40 minutes. Since you, like many of us, may see your physician only once a year, it is important for you to have your physician’s complete attention and to have all of your concerns addressed. Some of these concerns may be of a sensitive – even embarrassing – nature. Your physician may likewise ask you some probing questions about …
A pediatrician speaks out against combining sibling appointments
An interesting article in the journal Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students about; it is sobering because it describes the potential harm that can come from it, harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything.
Overdiagnosis is the term the authors use to describe …
The problem of overdiagnosis: What can patients do?
A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.
The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.
For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …
Don’t make me choose between motherhood and my career
Although pediatric (children’s) hospitals are not yet mandated (as are their general population counterparts) to participate in value-based contracts (VBCs), as competitive medical institutions they are very cognizant of the market changes toward value-based payment models while tirelessly seeking to increase value in pediatric health care delivery.
The push towards better alignment of payers and hospital systems continues to change the landscape of competitive health care. Children’s hospitals “are the backbone …
Are pediatric hospitals ready to embrace value-based payment models?
I am one of those lucky souls who actually likes their job. Since I completed my pediatrics residency two years ago, I have been working in urgent care settings. What’s not to like? I get to see a wide variety of patients, I’m always learning something new, and I get to finish my encounters with a high-five from an overeager toddler. If you’re a general pediatrician like me, that’s the …
The scourge of the pediatric urgent care fellowship
Doctors who disparage, or even ridicule, what parents tell them are, fortunately, rare. Nevertheless, sometimes parents may infer from what the doctor says or how he acts that he does not value what they are telling him, even though he did not mean to imply such a thing. All physicians have had the experience of overly touchy parents inappropriately assuming from our questions that we do not respect their ability …
What to do with disparaging doctors
How doctors treat patients’ need for information has changed significantly over the past decades. Sixty years ago medical practice was much more paternalistic than it is now, although some would say it continues to be so in important ways. Still, not too long ago it was common for doctors to tell patients or their families next to nothing about what was going on. The presumption always was: the doctor knows …
What to do with physicians who don’t explain
The common practice in this country (although not everywhere — Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. …
Are antibiotics needed for your child with an ear infection?
Recently, a friend’s mother asked me how to best support her daughter’s decision to breastfeed her first grandchild. The new grandmother questioned her ability to encourage her daughter’s decision because she had not breastfed her own child, and this lack of experience made her feel unqualified to provide support. With mixed emotions and a lingering sense of guilt, this new grandmother wanted to learn, from a pediatrician friend, how best …
Bottle-feeding grandmothers vs. breastfeeding daughters: advice from a pediatrician
A lot of parents ask me about the HPV vaccine, “Isn’t that the optional one?” Well, let me walk you through why my answer to that question is a hard “no.”
Human papillomavirus (HPV) is a virus that causes warts and several types of cancer. There are over 200 different strains of HPV, some of which tend to cause warts on the hands, feet, or face. Other strains …
No, the HPV vaccine isn’t optional
The following is something I wrote for our annual memorial service for children who have died at our Children’s Hospital. But these same thoughts are with me every day.
It’s an honor to be here with you to celebrate the lives of our patients. Thank you for being here. Thank you for sharing your children’s lives with all of us. Speaking for the staff of the children’s hospital, thank you for …
Thank you for letting us be a part of your child’s life. You truly are the heroes of medicine.
Being a doctor mom is a beautiful paradox of feeling like a badass one moment and a frazzled I-don’t-know-what-the-heck-I-am-doing mess of a person. Being a female physician, the majority of us feel there is a societal and cultural pressure to be perfect all the time in every sphere of our life: as a professional, parent, and person. Obviously, expecting perfection is a bit unrealistic.
Among doctor moms, there are some common …
The truth and challenges of being a doctor mom
Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …
Important new information in the tragic cases of child abuse
There are roughly 15 percent of the nation’s children who suffer from a developmental-behavioral condition or about 1 in 6 children. Unfortunately, many of those children often do not get the help they need.
Children with developmental and behavioral challenges can easily be missed, especially when the behaviors are more subtle or impacts on function are not evident daily, such as with a …
It’s time to acknowledge the developmental behavioral pediatric workforce
Some children present to me with complex problems or multiple problems that fail to resolve after the typical interventions.
I recall a child with severe abdominal pain. He had tried numerous medicines and had had scopes and studies galore. It had reached the point where he was being scheduled for exploratory surgery to try and see the cause of his pain. I lost track of his case when I rotated elsewhere …
Adverse childhood experiences: How changing a child’s environment can help
Parents often ask me about snacks for their children once they are eating table food. Should they even give them snacks? If so, what kinds are good for them, and how often? In general, after age one I recommend three kid-size meals and 1 to 2 snacks to help them get their daily nutritional requirements. Try not to stress or obsess at each feeding about them eating all that you …
A pediatrician’s tips for your kids’ snacking habits
“Try this,” whispers Kate Winslet as I wander past the Lancôme counter. “Your glowing skin will thank you.”
The consequences of a celebrity endorsement are seemingly harmless when it comes to revamping a makeup routine, but what happens when this type of advertisement seeps into the world of health care? It has been proven many times that celebrity endorsements influence decisions about specific political candidates, issues or parties, and the positive …
The consequences of celebrity endorsements in health care
As our society’s awareness of mental-health issues increases, the idea of balancing personal and professional life has become a central topic of conversation. It cannot be disputed that finding a healthy equilibrium is especially important for mothers who enter the professional world, medical or otherwise. As a student in an accelerated post-baccalaureate pre-health program and a mother of a 3-year-old girl and a 10-month-old boy, I have made many strides …
Does work-life balance really exist for young mothers pursuing medical careers?
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