Joy of Medicine: perspective

Welcome back to the discussion about finding joy in the craziness of medicine, especially in pediatrics. Pediatrics offers a unique perspective on others' lives, and the best part of it is the children. They are incredible creatures who rarely judge those who care for them based on race, religion, politics, or any other factor, except when they are being treated or injected. The interaction between a child and a pediatrician is often tied to a good joke, a sticker, or a popsicle on the way out the door, and children quickly forgive and forget.

However, children's perspective is limited, and where they live, how they grow up, what school they attend, and how they are treated are not up to them, and they may not know differently. Ironically, the same can often be said of their pediatricians, who enter the medical profession with their narrow view of the world and how they grew up seeing it, with limitations, biases, and very little understanding of how those who did not grow up in the sameness of their world differ in so many ways.

As a pediatric emergency physician, one's clinical experience changes one's worldview. Medicine's true joy comes from having one's mind repeatedly changed, realizing how little one knows about the real world, and the frustration and burnout that come from all those things we cannot fix, things that others try to fix without any understanding of the real challenges.

For example, let's consider the case in the image above. A mother brings a child to the emergency room (ER) 26 times in two years, complaining of cough. The various reactions to this case can be: a tired clinician who thinks the mother is wasting their time, a politician who sees it as a waste of taxpayers' money and wonders why the mother isn't at her primary care physician's office, a school principal who is glad to see the child has a doctor's note so that they can return to school, or a lay person who thinks the mother should have to pay for this and believes most ER visits are unnecessary. The hospital administrator sees this as great because the ER's volumes keep rising, while the technologist wishes the mother had gone to Dr. Google instead of coming to the ER.

Finally, as a pediatric emergency physician, my perspective was to educate the mother on when it's appropriate to come to the ER, ensure that she has a pediatrician if she doesn't already have one, and quickly find a way to discharge her so I can move onto the next patient. I confidently ask what brings her and her child to the ED and ready my speech on all of the above. But, mom was ready for me. She tells me that "you just don't get it." She explains that she has a minimum wage job and cannot afford to leave work or risk getting fired. She works from 9 a.m. to 5 p.m. on weekdays and has insurance that assigns her to a local health center that is also open from 9 a.m. to 5 p.m. on weekdays. She takes the bus to work and two buses to get to the ER, and she is worried that her child might have an ear infection that will worsen. She needs a note for her child to return to daycare, or she will have to miss work. If she has to miss work she needs a note. She came to our ER which was farther than other places because she knows that we are specially trained to care for kids, and she trusts our care. She has stopped at the other places but they typically tell her to come here. She has felt shamed by some who refuse her insurance.

Pediatrics is a unique profession that allows one to gain a new perspective on others' lives, and it is the children who make it worth the while. Despite our limitations, biases, and narrow worldview, pediatric emergency physicians can learn from their clinical experience and find joy in changing their minds repeatedly. Understanding the real challenges that patients face can help us all do a better job of fixing the real problems while also passing much less judgement on those in the real world.

I would imagine we could improve healthcare, lessen burnout and improve outcomes if we actually listened to the needs of our society... offer primary care that is accessible , re-evaluate the educational and employer demand for "doctors" notes, build technology that fosters relationships and meets needs... on and on ... this one case changed how I perceived solutions and was a big reason I started Anytime Telecare . Why do we demand so much from patients and yet give them so little in return? Why can't we find ways to meet the needs of ALL patients thru primary care, trusted relationships and technology that binds them.

Want to find more joy? Walk in other's footsteps without judgement.. you will find heroes in those working hard to take care of their kids .. Kudos to this Mom, I will never forget her.

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes.?