On Being a Pediatrician

1. On Being a Pediatrician Alan W. Cross, MD Professor of Social Medicine and Pediatrics Clinical Professor of Maternal and Child Health “Practicing” pediatrics about 20% time as a part of faculty activities at UNC since 1978. My practice is unusual compared with community pediatricians. I have about 200 patients.

2. Pediatrics Is… Upbeat, Happy, Positive, Health is the Default, Good Outcomes Most of the Time, Grow Up and Do Well

3. Pediatrics Is…. Upbeat, even in the face of great hardships of poverty or deprivation

4. Kids are - honest! They tell you things that adults would never say. “Your hands are cold!”, 10 year old “Your breath smells!”, 5 year old while I am looking in his ears. “You need to wipe your nose!”, 12 year old whose throat I am about to look into.

5. Kids are – innocent and curious Their curiosity is huge and their questions are genuine A 5 yr old sits up as I start to examine her abdomen – “What is that bump in my belly button?”

6. Kids and Trust Trust can be very difficult to earn Kids and parents are skeptical Once you have earned trust – Never abuse it Don’t take it for granted

7. Parents Often struggling to do what is best seek your guidance on many issues, open to many suggestions, Deeply appreciative of your assistance. Support the entire family and the child benefits greatly.

8. child development is highly predictable

9. Pediatric Core Concepts Pediatrics is the complex interactions of child development and pathologic forces. Child development is a highly predictable sequence of events that involves all organ systems. The stage of development profoundly influences: Likelihood of specific diseases The impact of the pathologic force The most effective treatment The outcome – short term and long term

10. Pediatric Core Concepts 2. Children are embedded in the context of a family and community and their problems need to be dealt with in that setting.

11. Pediatric Core Concepts 2. Children are embedded in the context of a family and community and their problems need to be dealt with in that setting. a. The child’s well being is totally dependant on the family’s well being. b. The community can provide many resources for the family and child – social support, programs, direct assistance.

12. Pediatric Core Concepts 3. Triangular relationship – Child Doctor Family careful negotiations primary and secondary responsibilities conflicts of interest – child and parent particular needs of teens

13. Challenges of Pediatrics Respond to patient and family concerns – not just diagnosis and treatment Communicate with all the age groups – like so many different “primitive tribes” Multiple sources of information – child, parent, school – hard to sort through all the biases. “truth” can be illusive. Usually one straight forward problem – often medically simple – much is routine, such as well child care

14. Challenges of Pediatrics Treatment must fit within the means of the family – limitations may be frustrating. Education is major part of job – parents, kids, teens, teachers etc. Advocacy and community work – tradition of working at a population level – school health, policy, special populations,

15. Rewards of Pediatrics Small changes make a big difference over time – delayed gratification often required. infanttime adult

16. Rewards of Pediatrics Develop long term relationships with patients – develop a deep understanding and a strong bond of respect and trust

17. Rewards of Pediatrics You stay young – I recently had my 53rd 12th birthday

18. Rules of Pediatrics Never lie!! – NEVER Always show respect – speak to the child, ask permission, explain what is happening, seek and answer questions. Always keep your word!! – if you say you are going to do something, make sure you do. They don’t expect that. Stay humble – never believe you are as good as they say you are – no M Deity.