I don’t know you and you don’t know me, but today you become one of the most important people in my life. You are the one. The one who I’ve entrusted to take care of my girl in my absence. The one who I’ve tasked with teaching her things that I cannot. The one who will make an indelible mark on her …
On the first day of school, a letter to my child’s teacher
I’m all for free speech and I’m very hostile to censorship. The response to ugly speech is not censorship, but is rebuttal speech. Of course, there’s a lot of speech out there that should never be uttered. Indecent and rude speech is constitutionally protected, but is usually a poor choice. We have the right to make speech that is wrong.
I relish my free speech in the office with patients. I …
The consequences of prohibiting physicians’ free speech
Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had …
Sleep apnea in children: A primer from a pediatric intensivist
When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s. As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly …
When medications devalue the opportunity to listen
We live in a digital age. Technology has become an integral part of how we see, learn about, and interact with the world. From computers at the office, to televisions at home, to smartphones on the bus or in the grocery line, many of us spend over half of our waking lives in front of a screen.
Naturally, some of us have begun to worry about the effects this may have …
How digital media can help parents bond with their children
I see it again and again in my practice: parents who seem to have forgotten that they are in charge.
“You can say no,” I find myself saying to family after family. Which is kind of an amazing thing to have to say, if you think about it. You’d think that parents would know that they can say no when their child asks for yet another toy, to watch more television, …
Being a good parent means being unpopular sometimes
In a recent post, I wrote about the value of a yearly checkup with your child’s doctor — it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips.
First, and most important at all, go to the visit. You’d be surprised how often children are brought by …
How to get the most out of your pediatrician’s checkup
Recently I attended a national academic conference, and while I’ll admit that, having brought my husband and son along for the trip, the balance of time spent was skewed more toward pool and beach activities than academic sessions, I did indeed attend several and overall they were of good quality. One left me somewhat disappointed, though, because although it addressed what I would consider an important topic within my field, …
Can we get more from our medical meetings?
Call it concierge, call it direct care, boutique, fee-for-service, call it what you will. I call it a solution. As physicians, we’re all solutionists, are we not? With every differential diagnosis, assessment, and plan, we are creating solutions. In accordance, one does not become a doctor for any reason other than changing the world. Perhaps this change happens one patient at a time, but working toward a greater cause and putting …
Solutionist medicine: How the concierge model can reinvent primary care
There’s been an ongoing court battle here in the state of Florida over whether physicians have the right to ask families about gun ownership in their home.
The Florida Privacy of Firearm Owners Act was signed into law by Governor Rick Scott in 2011. This law prevents pediatricians from inquiring about gun ownership and discussing relevant safety information regarding how guns are stored and how to protect children from accidental injury. …
Educate your children about guns
Yearly checkups for school-aged and older kids can be a great opportunity to help your child stay healthy. Don’t skimp by relying on a cheapo sports physical at a local drug store. They cannot offer the kinds of important things your own doctor’s office can do for your child at a yearly well check.
We’ll review old issues and problems. Still getting …
Your children deserve more than a minute at a clinic
Florida politicians will not change pediatrician resolve to advocate for and protect children. There’s no question that a gag order cannot halt a passionate child advocate. I’d call the recent Florida ruling a dull tool taken to a very sharp crowd. Consider this post an open letter to Florida politicians.
I live as far away from Florida as any continental American (you do the math) yet Florida politics affect pediatricians and …
A gag order cannot halt a passionate child advocate
As most everyone knows, medicine is not an exact science. Every patient and every family must be treated individually. We all recognize that many things have the possibility of not going perfectly, especially when an ill child presents to the hospital. I am lucky enough to be a part of many families’ experiences at the hospital that go so well that you want to tell people about them.
Goodness knows, there …
A case that illustrates the way medicine is meant to be
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Recently I was the only witness to testify against local medical marijuana legislation. The bill, already endorsed by all members of the Council of the District of Columbia, would allow use of marijuana for “any condition for which treatment with medical marijuana would be beneficial, as determined by the patient’s physician.” As I waited hours for my turn to highlight the medical evidence about marijuana’s health effects, I sat silently, taking in …
Medicine by public opinion: Where are the doctors?
Up until 1988, being board certified in pediatrics was a voluntary process of passing the board exam once in a career. The American Board of Pediatrics (ABP) apparently realized this process didn’t make them much money, so in 1989, they abruptly ended “lifetime certification” and required an open book test and the associated fee every seven years. I was in pediatric residency during this maintenance of certification …
The mission creep of maintenance of certification
I have made several observations as to why developmentally challenged people are losing out in our health care systems. Given that there are 11 million children in the United States with an emotional, developmental or behavioral condition, we really can’t afford to neglect this important issue.
My first observation is that primary care remains a chronically undervalued component of health care delivery in the U.S. Despite the 60 million Americans …
Our health system doesn’t serve the developmentally challenged
I flunk as a parent. I have no plans for my youngest kids this summer.
The older ones are working. But the 13-year-old and 8-year-old, the ones at the formative stages of their academic and skill development (if you believe what everyone says), are doing squat. No camp. No enriching activities. No special trips. Well, we do rent a house at the beach for two weeks every summer, that’s something, but …
Kids in the summer: There’s more to it than academic progress
I really hate it when a nurse practitioner is called a mid-level provider.
“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.
The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …
Stop calling nurse practitioners mid-level providers
In just a few days I’ll be leaving the clinic where I’ve practiced pediatrics for the past six years. The last months have been a flurry of last visits with families, paperwork, and tying up loose ends. There have been many, many goodbyes. I’ve been deeply moved by the expressions of gratitude and affection that many families have shared with me. It seems it is always in these times of change …
A pediatrician reflects, with deep gratitude to her patients
A couple of weeks ago, my family was traveling out of town. I was driving and my wife and almost 2-year-old daughter were buckled up in the back seat playing with some toys. My wife pulled out a brand new container of Play-Doh. As my daughter was preparing to pull the lid off to see what was inside, I drove through a section on the interstate where there was a …
Vaccine denial: A case of toddler logic syndrome
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