As I am currently completing my first rotation in Pediatrics as part of my Family Medicine Residency training, I thought it would be an opportune time to discuss my approach to holistic pediatric (and even adult) medicine. Over the past few weeks, I have seen numerous children in the hospital and outpatient setting. From the 2-hour newborn to the 18 year-old struggling with a complex psychosocial situation, I have been quite impressed with the depth of knowledge required to be a pediatric hospitalist and general pediatrician.
I often joke with my brother's girlfriend, who is a veterinary technical assistant, that being a doctor should be simple, you are just responsible for one species. When it comes to taking care of kids, however, the idea that they are all Homo sapiens somehow is just too hard to believe. Developmentally complex, children can be categorized by certain physical and cognitive milestones, but in reality, this is just a snap-shot reflection of the person he or she currently is, and may have no bearing on the adult he she will eventually become.
Nurturing and caring for our youth is something near and dear to my heart. Having grown up with all younger cousins, I literally saw the growth of my relatives from diapers, to tricycles and rec soccer, to finally graduating high school and moving on to college. I currently have been serving for almost 2 years in my local church’s Children’s Ministry, teaching, learning and growing with elementary age kids, seeking to further a relationship with Christ and live a joyful, playful and overall meaningful life.
If I were to tell you that the most important part of their physical maturation was constant oversight from a pediatrician during well child checks, sports physicals, the occasional visit during a tough cold, or the acute visit for that really weird rash, you might think this to be a grand overstatement. But take a closer look at this thought, and what you might find instead, even when we start to consider the acute illness requiring hospitalization, is a relationship of trust whereby the pediatrician, hospitalist or family physician is able to nurture the growth of a child, simply by being a positive presence, someone who genuinely and deeply cares.
It has become very obvious to me, that even in the hospital setting, that many of my discussions revolve not around specific aspects of a particular illness or presenting complaint, but on how a kid is doing in life. What sports do they play, are they involved in dance or art, how much are they sleeping, do they have any problems with their diet- too much candy, food intolerances, not eating enough vegetables, binging on ice cream and Chinese food, how was life at school, do they have close friends, if they have siblings what is their relationship like, have they been able to travel to another state or country, what do they want to do when they grow up, what was the coolest thing they’ve done in the past week?
To me, taking a history is so far removed from asking about quality, duration and onset of pain, or reciting a laundry list of questions for a complete review of systems that I sometimes even forget where I am even working. Even when these components are required as part of a complete medical encounter, I will always seek to inquire about total well-being: social, spiritual, physical, and emotional.
I will be the first to admit that I have previously worked extensively with a psychologist, seeking to improve my overall well-being, digging deeper into my weaknesses and fears, and making sense of any thoughts or doubts that would swim through my mind. While this relationship worked for me, it may not be right for you, but what I encourage of everyone is to find that person in one’s life with whom these types of discussions can occur, completely safe, secure and free of judgment. It certainly does not have to be with a trained psychologist or even a family member or friend, the arrangement and sense of true acceptance are all that matter.
Expanding from this encouragement to pursue and develop an open and supportive relationship in one’s life, I have thought more and more about my many pediatric encounters, and it has become entirely clear, that perhaps, such a dynamic and supportive relationship is being shaped without the child, family or doctor even being aware of its supportive construction. Through thoughtful and meaningful interaction over a period of time, a general pediatrician or pediatric hospitalist can become a trusted presence in a child’s life such that the child can actually begin to cultivate a greater sense of positive well-being and adopt new self care practices to hopefully prevent future illness.
Taken to the hospital setting, one can begin to see the potential for truly impactful change during a period of serious illness and relative stress. No one wishes to be in the hospital, and I would argue that the only thing people want more than to leave the hospital is to never come back. As such, I realize that the hours, days and potential week spent in a hospital can be a monumentally productive time where a vulnerable child and family can become much more willing and engaged to learn why their child ended up in the hospital in the first place and what exactly can be done to prevent any future hospital visits.
But learning and prevention take time and effort. If a doctor is only willing to perform rounds and get the “EMR” completed without a second or third visit to speak with a family, much of this potential growth will never be realized. I can certainly say that overall workload and EMR obligations make this type of care more challenging, but for someone just 3 weeks into learning how to be a pediatric hospital MD, it is indeed possible, it is simply a question of priority, awareness and mindful intention.
Have I been able to engage in such discussions with all of my patients and families- of course not. Could I be doing more- certainly. But what I realize and want to convey to you is simply knowing YOU CAN. Whether in the hospital, on the sports field or general clinic YOU CAN. We CAN. We ALL CAN. We can be the positive presence a child and family need to heal, grow and open, allowing them to share all of their worries or when they are hurting or when things get tough.
It’s a fact of life that we all want to be happy, healthy and remain free of suffering. Sometimes, however, illness, negative thoughts, and unexpected life events can cause upheaval in this balance. While I always hope to have people in my life that I can turn to when times are difficult, I ultimately want to know that I have the tools and personal resiliency myself to face any challenges, all the while, knowing I have a support team waiting in the wings to catch me should I stumble.
Being a pediatrician or pediatric hospitalist can be so much more than simply being the “kid” doctor. We can empower kids as their families to be owners of their health and vitality. As I have said many times before, the hospital is all too often the home of sick care and the outpatient clinic the home of chronic band-aids. I am never one to discredit the value of hospitals, and certainly do not want to come across as someone who sees hospital care as completely dysfunctional, I merely want to suggest that there is an alternative when it comes to how we use our time, where we direct our energy and what we actually offer as supportive resources.
Will the hospitals of today ever become holistic acute care centers incorporating lifestyle medicine as their foundation, allowing patients to sleep on regular schedules, eat whole and nourishing food, engage in communal connection with others whether in play, spiritual bonding or simple conversation, discover practices to help reduce stress and support resilience, all while additionally having access to specialized technology delivering appropriate and cost-effective acute care when necessary, I have no clue. Maybe we need a replacement for the hospital all together? Once again, I have no clue.
What I do know is this: as health care providers, we must open to cultivate a relationship of positive intention no matter the patient’s circumstance or environment for healthcare delivery. We must be in it for the long term supportive relationship even if it appears we will be only a part of this person’s life for 2 days. We must care and love our patients enough to show them how to heal, to become resilient, and to forever flourish. While the specialized tools at my disposal may be drastically different in the hospital setting versus the outpatient clinic, the space and intention I hold will always be the same, and guess what, lifestyle medicine will always be accessible. Always.
To close I give you the essence of my intention when delivering medical care to all.
Remove the obstacles to cure, educate individuals about new ways of living this most precious life, support people as they navigate such challenging obstacles and engage in a relationship founded on love.
Remove, Educate, Support and Love.
This is my purpose, this is my mantra,
This is my life.