Sunday, June 29, 2008

Pediatricians and guns

I was listening to NPR the other morning as I was getting ready for work, and I heard about the Supreme Court decision regarding Washington DC's gun restrictions. I immediately started thinking about the AAP reaction to this news, and sure enough, there was already an email news alert waiting for me in my inbox when I got to work.

I live in an area where many, if not most, people have guns at home; in fact, I suspect my entire AAP district, district VIII, has a fairly high gun ownership rate, as it includes Wyoming, Montana, Alaska, Washington, Oregon, Idaho, Utah, Nevada, Colorado, Arizona, New Mexico, and Hawaii (although I honestly know little about gun ownership there). Some of my patients hunt regularly with their parents, and other families keep guns for protection. I address the topic daily, using any teachable moment I can to ascertain which families are aware of gun safety, and which are not. I cringe when I hear about the loaded gun under the pillow. Any gun in the home is a potential weapon, a tool for suicide, altogether a danger.

During medical school and residency, I took care of several children who were the victims of accidental shootings. One teenager in particular comes to mind. He and his brother, who were well-versed in gun safety and had various guns of their own, decided to clean their dad's shotgun as a surprise to him. Unfortunately, there was a shell in the chamber, and in the process of cleaning, the one brother accidentally shot his brother's eye out, nearly killing him in the process. Their parents were horrified at the carelessness of the one boy because they had taught them about gun safety, but they were home alone, unsupervised.

This was a tragic accident. I feel strongly that, even with "trained" children at home, guns should be kept in a safe that only the adults have access to. In other words, we should try to eliminate access to guns in unsupervised situations, although I am aware that accidents also happen when an adult is present. I also believe that there are types of guns that should not be sold to private citizens. However, what irks me about this whole issue is that children are exposed to many dangers all the time, and we don't have that knee jerk reaction that we have with guns. We've all had parents tell us that they would never have a gun in the home because it's not safe, yet they smoke in the home and allow their children to get out of their carseat because "they just won't stay in;" these are all potentially detrimental to the health of their child, and I try to make that point with the families.

I suppose that my point is that we, as adults, need to protect our children by putting them in car seats, by locking up guns, by feeding them healthful foods, by locking up the bleach, by immunizing them, etc. I know nobody disagrees on this point, I just wish that we would put as much effort into some of the less obvious dangers that they face as well!

Wednesday, June 25, 2008

physician health

As I discussed in my last post, I've been spending a fair bit of time reading other blogs, some pertinent to medicine, others not. It is quite striking to me the number of doctors who discuss having ADHD themselves and how they've learned to cope with it. With this in mind, I did some research to try to find the incidence and prevalence of ADHD in physicians, to no avail. There is a wealth of information available on the internet for parents of kids with ADHD, for physicians who make the diagnosis or treat patients who've been diagnosed by another medical/mental health professional, for adults with the diagnosis, etc. Even on pubmed, there is nothing that I could find.

However, that point aside, there is very interesting information on doctors as patients. We are taught early on that our job, as physicians, is to take care of other people, not to become sick ourselves. We refer patients to mental health professionals, but we don't go ourselves; if we have back pain, we tend to take some ibuprofen and keep going, perhaps not always the best approach! There is a book, "When Doctors Become Patients," written by a psychiatrist from Columbia University Medical Center, Dr. Robert Klitzman, discussed in a NY Times blog from February, 2008: I haven't read the book yet, but I would definitely like to. He discusses what he learned himself from illness, not just the misery of waiting for several hours to see the doctor, as many patients do, but communicating with the doctor, and especially, accepting the he himself was not invincible. I know that for myself, I try to do my own "doctoring" when possible, rather than to go see someone. Part of that is that I don't want to accept that I too become sick, and part of it has to do with living in a small town where I feel I need to go out-of-town for care for privacy issues. It's just interesting to think about this topic, that maybe we need become better patients ourselves to become better doctors. I am not suggesting we wallow in our times of illness, but to be aware that we can learn from these experiences and use them to improve ourselves professionally.

Please excuse me while I go on a hunt for this book! And, thanks to Andy for the hint of the shortened URLs!!

Thursday, June 19, 2008

As I'm new to this world of blogging, I'm learning a lot, which absolutely thrills me. There are lots of blogs by physicians out there; however, there is one in particular I enjoy reading:
The author is an eloquent surgeon and his ramblings are fascinating. Needless to say, I feel as though my posts are rather childish and mundane compared to his.

He posted a story today about a mother who was reported to "the authorities" for concern for possible abuse, based on a report by a psychic that the adolescent's educational assistant had gone to see the night before. Yes, a psychic. Do check out the site, as the full story is unbelievable! Now, we've all heard that psychics/astrologists and the like have apparently been consulted by various occupants of the White House, but to base a report to child authorities on this seems absolutely insane. I understand that we live in a world where harm can come to children, unfortunately, and all of us who work with children, be it as teachers, doctors, school bus drivers, whoever, need to be vigilant, but we must use our common sense. This particular story had a happy ending for the family, but I imagine that that is not always the case when a false report gets filed. I worry about both ends of the spectrum - missing a case of non-accidental trauma or sexual abuse AND giving a false, or what turns out to be false, report. Obviously, the latter is preferable in the long run for the child but can be devastating to a family. Anyway, I'm not saying anything people don't know, so I will stop.

I am thrilled to be part of this blogging community. I'm looking forward to seeing how other people's minds work and to becoming another rambling physician....

Sunday, June 15, 2008

Father's Day

Today is Father's Day, a day where families across the US are celebrating with cook-outs, watching the NBA finals, or just relaxing. These days, unfortunately, I only get to reminisce about the fantastic father I had. He was an extremely intelligent, well-educated, well-spoken man who was a loving father and husband. Although he was a nuclear physicist, he knew classical music very well, and he loved geography and history. He survived multiple harrowing experiences in WWII but then had tremendous opportunities after the war. He spent time in the Sahara Desert doing research, as well as two trips to the North Pole. After meeting my mother, he did work at several particle accelerators both in Europe and the US.

But on Father's Day, and nearly every other day, I remember him as a caring father who, despite being the traditional man who ruled the roost, encouraged his three daughters to become anything they wanted to, there were no limits for what we could do. It's kind of funny, but he preferred my mother not to work but to pursue the old-fashioned role of a mother, a la June Cleaver, but for his daughters, he was different! He taught us how to chop wood, change tires, mow the lawn, etc... All of us loved to help him in his woodshop when he was building furniture for our family.

English was not his first language, and he always struggled with idioms, a problem that he passed on to me. He loved to discuss one of his favorite books, Nothing Doing on the West Side, aka All Quiet on the Western Front. He also bragged about having quit smoking "dead duck." We were always amused by his sayings, although, as I mentioned, I learned well from him and can't get an idiom straight myself. He kept his charming accent throughout his life, along with his ability to speak multiple languages.

Today, I celebrate what he passed on to me, a love of nature and the outdoors, a love of music and literature, and a strong will (which when I was a teenager he called pigheadedness!). Even though he died nearly six years ago, I think of him nearly every day, and I will always miss him. He was a wonderful role model, and I wish I could have shared him with more kids!

Tuesday, June 10, 2008

dealing with parents

I just read an interesting article in the NYTimes, I think all of us have families with challenging members. I know which families are non-compliant, which ones go to the local emergency room to get the antibiotics that I wouldn't prescribe for their colds, which ones treat themselves first with medicines from across the border, and which ones just plain don't like me. These relationships can be difficult because I come to dread the visits - I see their names on my schedule, and I immediately feel on the edge. But I have also had the wonderful opportunity to see some of these interactions change for the better. I work hard to communicate, to explain my thinking behind my actions, and my office staff also works very hard at it. The author talks about the mother not believing in preventive care, which is our middle name, and that interfering with his relationship with her. Would he fire families who don't immunize? I doubt it. This group of patients frustrate me no end, but I encourage them to keep coming to see me, so that at least their children are getting care when they're sick. I wouldn't dream of "firing" them, even though their beliefs are so opposite mine.

Sadly for my patients, I'm all they've got; if they don't like me, then they have to drive 75 miles up or down the interstate to find another pediatrician. And with that in mind, I would not feel right for taking the author's position and firing the patient because I don't like his mother; if they fire me despite my efforts to establish rapport, so be it, you can't please everyone!

Friday, June 6, 2008


Oh how these four little letters can stir up so much debate!! Speaking of debate, I won't address politics anymore; it made me feel too weird. Next time I am lacking ideas, I'll simply talk about the weather or nail polish colors.

So, do you think this kid in the cartoon was actually listening to Dad reading the story, or thinking about the DVD he watched, the new video game he learned, etc.? But he clearly has a skill, even if it's one his parent doesn't have!

As a pediatrician, I get lots of questions from families, friends, and patients about ADHD. Having worked in early intervention in the 90s when the diagnosis was becoming quite fashionable, I had a non-medical perspective, one that was more influenced by families and preschool/daycare teachers. From this view point, I saw children who were quite intelligent, but parents and teachers had a hard time working with them due their distractability and/or inattention. These children were often in classrooms with many children, some typically-developing, some with special needs. The challenge in the classroom was huge. As an early interventionist, I would try to work with the teachers and the child in the classroom to help them learn to work together. Often, I would request that a child be put in a smaller class or a different center all together. However, this was not always an option.

Then, I went to medical school. In my pharmacy class, I learned how the different stimulants affect the brain and the body; I obediently learned the different dosing schedules, half-lives, metabolites, etc. I was exposed to pediatricians who felt that the diagnosis was a farce, an excuse for poor parenting and teaching, as well as pediatricians who were committed to the diagnosis. During residency, I worked with one pediatrician who felt that pharmacotherapy was most indicated when a child's self-esteem was affected by the ADHD - this has really stuck with me, and I continue to use it as a guideline in my practice.

Now I am a pediatrician, simply with a background in early intervention and special education. I was also diagnosed with ADHD during medical school, in case you hadn't guessed already! I love taking care of these patients who tend to be quite imaginative and often questioning of authority; it is incredibly rewarding, yet quite frustrating at times. I spend a lot of time discussing non-pharmacologic ways of dealing with ADHD, including regular exercise, good sleep hygiene, healthful diet, and strength-based learning, as illustrated by the cartoon at the top of this blog. However, as we all know, these strategies don't always work; parents do not always have the option of putting their child in a private/charter/alternative school, and homeschooling can be difficult as often the parents have ADHD themselves. And incredible results can be obtained sometimes with the right medication, in conjunction with everything else. Ultimately, my goal is to teach kids how to cope with school and ideally to excel in school, how to live with rules, and how to navigate in a tremendously busy world with many distractions. Unfortunately, I know that some will try self-medicating, some will struggle with depression, but I remind myself that with help, many can be successful, bright, innovative leaders.

There are lots and lots of resources out there for ADHD, but here is a website that I find is a good place to start:

Thursday, June 5, 2008


I am just not feeling very inspired, so I'm stuck writing about something that has had me fired up for several months now, even if it is political.

Is anybody else confused and annoyed by the presidential campaign of Hillary Clinton? Maureen Dowd, in yesterday's NY Times, wrote an excellent op-ed column on the subject. Then I heard on NPR this morning that she and Bill will host a party on Saturday night in Washington, DC, which will officially "suspend" her campaign. What does that mean? Does it mean that she'll be ready to go in case Obama changes his mind and decides that he doesn't want to be president after all? I agree with the democrats that they need to focus on unifying the party to improve the chances of not only winning the presidency, but also winning seats in both houses. McCain has had the full support of his party for several months now, and even though the race between Clinton and Obama has somewhat overshadowed his campaign, he has been able to focus on his and his party's ultimate goal.

Anyway, now that I've discussed my political views with my readers, I feel better. Maybe this post will prompt some discussion!