EVERYTHING
FOR YOUR FAMILY
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It's 9 p.m. on a Sunday night. Your baby's temperature shot up a few hours ago and has been teetering over 100° ever since. Now she's fussing and crying inconsolably, and you're starting to get worried. What do you do? That's simple: Call your pediatrician. Many of us take for granted the knowledge, expertise and accessibility pediatricians offer us today, but did you ever stop and wonder what makes these doctors want to field phone calls in the middle of the night, try to figure out what's wrong with patients who can't even talk to them, or discuss yesterday's tally of poopy diapers with yet another anxious parent? Ask any pediatrician and she will admit that there are other medical specialties with shorter hours, higher salaries, and easier schedules. Yet the number of medical students signing on continues to grow, especially among women. The American Academy of Pediatrics has about 40,000 members across the country, and about 10% of them practice in Orange County. That's not surprising. Next year, 1.2 of every 10 babies in California will be born in Orange County, according to the Department of Finance Demographic Research Unit. That's an estimated 44,705 newborns. But the question remains, with all of the choices modern medicine has to offer, why are so many attracted to pediatrics? If we could sum up all the reasons a handful of local pediatricians shared with us, it would come down to one thing - the children themselves. Throughout history, pediatricians have always been a progressive bunch, banding together to promote children's health and welfare and educating parents and society about the special needs of children. But even today, when preventive medicine has eliminated so many of the deadliest threats to children, pediatricians still keep one eye focused on the future. The doctors we talked to seemed most interested in the opportunity to help shape a child's life in a positive way, through long-term relationships with families. They relish the opportunity to provide guidance, support and care during the journey from birth to adulthood, and they say that the rewards of the job far outweigh the piles of paperwork, the days of overbooked office appointments, the unending hospital rounds, and even the occasional heartbreaking terminal illness. Perhaps most telling, they all admit that given the chance to do it over again, they wouldn't change a thing. Why they became pediatricians "One of the things that attracted me to pediatrics is the feeling that you can have a positive influence on a future," says Dr. Clyde Wesp, a pediatrician whose more than 30 years of experience has taken him from stints as a pediatric resident to working with chronically ill children to a private pediatric practice in Orange County. In his opinion, pediatrics is not a "default" area of medicine that doctors happen into. It's an area that they seek for the collaborative environment, the challenge of the deductive reasoning required to determine a true health problem, and the opportunity to see the hope and promise of the "big picture" - a happy and healthy adult. Dr. Matthew Aney, who recently opened a pediatric practice in San Juan Capistrano, echoes Dr. Wesp's feelings about the impact a pediatrician can have on a child's future. "A big part of pediatrics is preventative medicine, not only when they're little but when they're teenagers facing issues like smoking, drugs, alcohol, and sex," says Dr. Aney. "I remember during my rotations seeing 60-year-old patients who were depending on oxygen to live. At that point, there was nothing that could be done for them, and I thought if only someone had gotten through to them when they were younger. As a pediatrician, you can definitely make a difference in someone's life." Dr. Paul Qaqundah, chairman for the department of pediatrics at Hoag Hospital and a practicing pediatrician in Huntington Beach, started his rotations in pediatric neurology and neurosurgery, but he soon grew discouraged over the extremely low survival rates of his patients. His energies were renewed, however, when he settled on general pediatrics and began witnessing a more positive atmosphere of quick recoveries among his patients. "Children can be seriously ill and bounce back very quickly," he says. "And even when they're hurt they still give you a hug." His years of experience have shown him firsthand what the future can hold for a child who's been given a second chance. Early in his career, he was in another country when he witnessed a 3-year-old boy being sent home to die. The boy weighed only 10 pounds and doctors had been unable to determine what was wrong with him. Dr. Qaqundah quickly realized that the child had Celiac disease, a condition that causes serious problems when you eat gluten (wheat, rye and barley). Dr. Qaqundah explained the situation to the parents, and today that patient has grown into a healthy 40-year-old who lives in Northern California. Recoveries like these are what fuels Dr. Qaqundah's love of pediatric medicine. "Happy medicine" Dr. Kirsten Sutter, an assistant clinical professor at UC Irvine and general pediatrician, agrees that pediatrics is "happy medicine." She says she always knew she wanted to be a doctor, but her rotation through pediatrics confirmed her specialty. "All you need is one child to really make you smile and laugh, and it makes your whole day," she says. As a teacher, she notes that the future doctors she works with are a unique crew. "It's a lot of fun to train residents, because these are people who really want to be there." Pediatric medicine, while it may be "happy" and purposeful, does have its share of tough times. Even with today's broad range of preventive medical practices, there are still some illnesses that affect children with devastating results, even death. Often it's the pediatrician who makes the initial discovery of a serious problem, and it's up to them to break the news to the family. Dr. Sutter recalls the time she examined a child suffering from a prolonged cough. "It was Good Friday, and when we took a chest X-ray, we discovered a huge tumor in his chest," she explains. "When I went in to visit him on Easter Sunday, his parents actually thanked me." Dr. Sutter realized that for those parents the fear of not knowing what was wrong with their son was as bad, if not worse, than the actual diagnosis. Luckily, once the tumor was discovered, he was treated and fully recovered. In fact, recently she even had a chance to talk to him and learn that he was attending a local college. However, sometimes, the diagnosis is not as optimistic, admits Dr. Wesp. He remembers a patient who came in for a stubborn sinus infection that turned out to be incurable leukemia. "When something like that happens, your role changes," he explains. "First you have to remind yourself that you are not responsible for the disease, and then you need to be there to support the patient and the family. Even though they may be seeing a specialist, they still sometimes depend on you to explain things and answer questions. You need to be there to help them through it all." "It breaks your heart when you have a child with a serious disease," says Dr. Qaqundah, recalling a patient he diagnosed with cystic fibrosis. "But when you see other kids getting better, you remember that it's worth it, and it makes you want to continue." While it can be emotionally draining to deal with the death of such a young patient, like Dr. Qaqundah said, it's the uplifting moments that provide pediatricians with the inspiration to keep going. For example, Dr. Wesp recently had the chance to see his efforts come full circle when he found himself being interviewed by a couple expecting a baby. The father was once a patient of his, who had suffered a diabetic coma at the age of 10. "He told me, 'Yours is the first face I remember seeing when I woke up. I wouldn't have anyone else take care of my baby,'" recounts Dr. Wesp. "Those are the kinds of things you enjoy as a pediatrician." Doctor-parent-patient triangle Pediatrics is not always an emotional roller coaster of highs and lows. One constant in the profession is the long-term relationships doctors develop with their patients and their patients' families. In fact, good care is totally dependent on a sound relationship between all 3 corners of this triangle, especially in the years before a child can communicate on his own. But how do parents look at this relationship? Is it one simply formed by necessity, or is it something more? Maura Short, a Laguna Beach mother of a 2-year-old, says that she believes it's important for parents to "click" with their child's doctor so that routine office visits and emergencies can both be handled smoothly. "It's a feeling," she says. "There has to be a level of trust and respect and a good rapport. I need to know that my doctor is going to be honest with me and make it a collaborative environment when we have to make decisions about my daughter's care." Every pediatrician has a game plan for making parent and child feel comfortable during an office visit. Dr. Qaqundah says he makes a point of acknowledging a parent as soon as he walks into the exam room, but then focusing on the child, talking to them, playing with them, and taking time to get them to feel at ease. "I want to be their friend. The trick is that they never get a shot while I'm around." Dr. Wesp explains that he tries to build relationships with parents based on information, resources and choices. "When you have a new parent with a new baby, you can just feel the anxiety in the room," he says. "We don't just communicate with the parent, but we do so in a way that helps them become more confident." Wesp believes it's necessary as a pediatrician to be open to cultural parenting differences and other issues parents might question, like immunizations. "They come to me for my expertise as a doctor, but it's their child. I try to give them my perspective so that we can make decisions together." "The relationship with parents is absolutely essential," agrees Dr. Sutter. "Not only from a professional perspective, but when you have a good relationship with the family, things like follow-up care, and taking medicine tend to be better as well." However, Dr. Sutter does feel that the relationship between parents and pediatricians is evolving with the advent of easy access to more medical information than ever before through the internet. "It used to be that whatever the doctor said, goes," she says. "But now that parents are doing their own research on the Internet, they can sometimes come up with incredibly detailed questions, and you've got to be prepared ." Looking back - looking ahead There was a time when doctors were simply not interested in treating children, they were difficult to communicate with, and children often died anyway. In the early 1900s, infant mortality rates of 200 deaths per 1,000 births were considered low. Bad weather, poor harvests and a simple diarrheal virus could could cause the number to soar in any given year. As new health practices were introduced - milk pasteurization, inoculations, prenatal care and well-baby visits - survival rates and life expectancy improved rapidly. As various medical organizations began to recognize the importance of children's medicine, specialized groups began to emerge - a pediatric branch of the American Medical Association, the American Pediatric Society and eventually the American Academy of Pediatrics. Science and technology kept pace, as researchers developed vaccines for some of the worst childhood diseases, and preventive medicine took the forefront. The number of doctors drawn to pediatrics has grown rapidly over the last 75 years. When the AAP started, there were approximately 350 members; today an estimated 65% of new pediatricians are women. But even though children's health has been become a priority, and the infant mortality rate has been drastically reduced to just over 7 per 1,000 births, there remain challenges. "We've come a long way in the last 100 years," says Dr. Wesp. "Prevention will always be important, but it might become a different kind of prevention. We're going to be dealing with the psychological aspects of maturation rather than some of the illnesses." Many physicians expect the advent of new science, especially genetic research, to play a big role in the future of pediatrics. And Dr. Wesp says that although the questions he hears about social issues, from patients and their parents, are still the same, though they are asked a lot earlier. However, the rapid growth of pediatric specialties has changed the way Dr. Wesp and other pediatricians manage their practice. "With all the specialties, advice nurses, neonatologists, and more, pediatricians can be primarily office-based and do what we do best." Of course, some things may never change about pediatrics, like the dedication of the doctors themselves, and the simple reasons they enjoy working with children. "I just love kids," says Dr. Qaqundah. "And with pediatrics you never get old yourself." Michele Piazzoni is a freelance writer and mother of three living in Folsom. She is a regular contributor to The Early Years and Getting Started. To reach her: mpiazzoni@hotmail.com. MILESTONES IN AMERICAN PEDIATRIC MEDICINE • 1721: The first inoculation for smallpox is developed and given • 1800: The smallpox vaccine is improved • 1820: The first formal courses on pediatric are offered in the U.S. at Yale • 1825: The first American pediatric textbook is published • 1854: The first Children's Hospital opens in Philadelphia • 1898: The first premature infant incubator station opens in Chicago • 1900: Diarrheal diseases are a leading cause of death among children; other common killers include diphtheria, whooping cough and measles • 1930: The American Academy of Pediatrics is formed • 1943: Penicillin is produced on a mass scale for the general public • 1949: The DTP vaccine is introduced • 1953: The Apgar scale is developed for newborns • 1955: Jonas Salk's polio vaccine goes public, putting an end to the epidemic • 1963: MMR vaccine becomes available • 1995: Chickenpox vaccine introduced • 2000: Pnuemococcol vaccine is offered to public - Researched by Michele Piazzoni 10 tips for choosing a pediatrician Ask the people you know and trust for a referral. Chances are your friends and neighbors will be more than willing to tell you what they like or dislike about their pediatrician. Schedule an interview. Most pediatricians will offer a private or group interview at no charge. Use this time to learn about office policies and average wait time. Come prepared with a list of questions. When you meet with a pediatrician, don't be afraid to discuss any parenting philosophies you feel strongly about. For example, if you advocate co-sleeping with an infant, or you don't believe in vaccinations, you probably want to find someone who understands your position. Ask the doctor exactly how your child's care will be handled during and after normal business hours. Can you expect a same-day appointment, if needed? How quickly will after-hours calls be returned? Are evening or Saturday appointments available? Does the office have a well-child waiting room and a sick-child waiting room? For many parents, this is key, though typically this is offered only in larger offices. Find out the doctor's qualifications and experience. Many pediatricians provide fliers for potential patients that include education, special training, and overall experience. If you already have a doctor, but you are unhappy, don't be afraid to change. Make the best decisions when it comes to your child's health. Seek an age-appropriate pediatrician. The doctor who watched over your toddler may not be the best for the same child who has just bloomed into a teenager. Verify your doctor. Contact the American Academy of Pediatrics (www.aap.org) and the American Medical Association (www.ama-Assn.org). Not only do you want a great doctor, but a competent one. Perhaps most importantly, does YOUR child respond well to the doctor? If not, move on. |
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