Monday, May 19, 2014

Nicely done?

Went to the pediatrician with my daughter for routine primary care visit.  I thought she (the pediatrician) did such a good job with my daughter in terms of the tenor and content of the discussion, the calm demeanor, the subtle but savvy questions, the listening, and the encouragement.  Promoting wellness, self -esteem, and balance.

Later in the evening, reflecting back on the visit (and talking with my spouse) I realized how similar the pediatrician’s approach seemed to my own approach with my tween patients.  Or at least was what I aim to do.  But then I wondered about how circular this is.  I like the pediatrician because she practices like I do. How self-congratulatory is that?  And yet, perhaps instead it's that she and I are similarly mediocre pediatricians. Regardless, my daughter stated after the visit that her pediatrician was the “best pediatrician ever.” (Present company excluded, of course.)  

Do you learn about doctoring when, as a MiM, you go to the doctors?  I have tried to over the years. And as a MiME (Mother in Medical Education), I teach some stuff too. Actually, we chose this pediatrician in part because she trained with us.  More circularity.  Nicely done!

11 comments:

  1. I had an excellent pediatrician, but back then maybe the ball got dropped between childhood and adulthood because I went to an OB for 15 year old heavy menses issues after having not needed a pediatrician for years. I was very defensive of and embarrassed about the adult questions she was probing me with when I was still a child in many arenas, and felt unable to communicate with her. I wish I had you both for pediatricians when I was a tween/adolescent. I am sure that my past situation is not unique. You sound amazing professionally and you have a lucky daughter.

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    1. Thanks Gizabeth. Talking with tweens and teens is an art (involving listening and somehow getting them to share and trust), and oh how I wish your OB had been more artful at it.

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    2. I switched when I got pregnant with my daughter. My current (and past for 12 years) OB is fantastic. Live and learn, right?

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  2. I definitely learn what to do and also what not to do when I or a loved one goes to the doctor.

    I have had some horrible experiences (taking Zo to the Dermatologist when he was an infant for a capillary malformation; sat for hours waiting, then the Attending spent 10 minutes discussing case reports and other things) and some excellent experiences (taking Zo to my Residency Director who is his Primary Pediatrician).

    As a trainer, I continue to learn by the great and not-so-great things I see while working with other clinicians. Did you tell her that she did a good job? I'm sure if you trained her she will be very happy to hear that you think she's doing a great job.

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    1. Will do! Definitely have to tell her.
      So interesting that you take Zo to your prog director... could make it harder, or maybe easier to ask questions. Glad your experiences have been excellent thus far.

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    2. My Program Director is amazing! We were looking for a local PCP when we started (after a bad experience with going to different Residents every time he was seen for a Well Child Check) and she offered some recommendations including herself. She is the PCP for several other residents' children. All members of my family (husband, grandparents on both sides) have come to appointments and everyone remarks about her amazing bedside manner, excellent education, and warmth. It is easier for me as a Resident because we mostly communicate by text and she makes house-calls if needed :-) Our entire family loves her.

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    3. That's wonderful! Side note, makes us strive to enhance resident continuity, in continuity clinic, eh?

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  3. Your patients are lucky to have you. Your daughter's pediatrician sounds wonderful.

    I mostly learn what not to do at the doctor's. Have had a string of truly uninspired, clinically unimpressive, poor bedside-mannered primary care providers assigned to me. (note: none physicians, not that there are such physicians out there, just noting.) However, now have a fantastic physician who is truly THE model of a good internist. Witnessing his clinical reasoning, skillful line of questioning, openness to the patient voice and insights is inspiring to me.

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    1. Thanks KC! I'm so glad you finally found someone fantastic (as you well deserve).

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  4. Both. I used to take my daughter to a teaching practice, and one of the residents was marvelous with her when she was about 4 and had otitis media. He talked to her more than he talked to me, put her at ease, and did a lovely job. But then there was the one who spent most of the visit with her back to us, using the computer. She didn't really look at Eve when she walked in, or she would have realized that the height and weight had been entered wrong. She said "She's 70th percentile weight". I said "That seems odd to me". She said "Well, that's what it said. You need to keep an eye on her". My daughter was and still is slim, and if she'd *looked* at the kid, she would have realized what happened. The rest of the visit followed suit. I didn't make an issue of the weight mistake but I did weigh her again a few weeks later and sure enough they'd plotted the number backwards - height for weight. We switched practices the following year.

    I've never taken my daughter to a pediatrician - she has always seen family practitioners. I'm an internist, and many of my colleagues think this is odd, particularly since we started with an NP (my choice - she was AWESOME and we'd still be with her if she hadn't moved out of state). Meanwhile, I've had to switch providers three times to find someone *I'm* comfortable with (Eve's doc doesn't take my insurance) and I'm seeing a family doc, too.

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    1. Thanks for sharing that perspective. No matter where technology brings us, we need to look at and listen to the patients and families in front of us... bad data is bad data, and even good data isn't worth ignoring the patient, oh my!

      Interesting that some families might all go to the same (family) doctor, indeed.

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