Dearest readers,
I’m a kid doctor. That might seem obvious coming from a newsletter with “pediatrician” in the title, but I say that statement with immense pride. There is no doubt that I chose wisely when I decided to become a pediatrician, despite the many diverse challenges of this job. Since hindsight is always much clearer than future prognostications, I now can see clearly that this profession really resonates with the career I hoped to build for myself when I was first finding my way in medicine. I love so many things about pediatrics---- its natural, upstream lens that relies on prevention as strategy for life long health, its focus on community as the fertile ground to “plant” children into, and its ultimate goal of collaborating with families to provide all children the opportunity to become their best, potentiated selves. This all sounds so beautiful, doesn’t it? But how do we, not just with words, but by carefully executed actions, transform these foundational beliefs into a daily reality? This month’s newsletter focuses on my favorite topic: how do we empower ALL kids, to equitably be seen and feel seen, within the limitations of a busy pediatric clinic in an urban, underserved setting?
A few years ago, I learned a much-needed lesson I carry with me every day that I walk into my clinic. I was several years deep into establishing my pediatric outpatient panel, diligently putting in the time and effort to maximize my diagnostic clinical skills while trying to still listen to patients in an impossibly concentrated amount of time. So many days left me feeling overwhelmed with the high demands of my patient population that often times exceeded the skill set my medical training had afforded me. I am not a social worker, case manager, housing authority, nor lawyer, all roles better suited to really help my families with their daily challenges. I continued to find and adhere well-fortified band aids to the gaping wounds of my patient families while wondering how I could better serve them.
Soon afterwards, I came across “The Deepest Well”, by Dr. Nadine Burke Harris, a fellow pediatrician and the first Surgeon General of California. In her writings, Dr Nadine brought order and framework to the systemic challenges my patients faced by discussing ACEs, or Adverse Childhood Experiences, and their hindrance on adults becoming positively engaged community members. ACEs encompass situations of neglect, abuse and household dysfunction (10 different categories in total) and children who are exposed to more than 4 ACEs are most vulnerable to various harmful, downstream effects into adulthood including major medical illness. Of greatest importance, children exposed to a significant number of ACEs have access to a special protective factor that can mitigate these potential harmful consequences—-the presence of at least one positive, buffering adult role model in their lives who supports and loves them.
Although I knew this intuitively, the research and data heartened me to the highest extent, reaffirmed the importance of my goal in supporting parents, and motivated me to practice pediatrics in my most personally authentic manner possible. For me, this authentic practice includes expressing to my patients that I love them, openly offering hugs during good and difficult times, looking children in the eyes when I speak to them, and always making sure to include them as the main focus of the appointment while parents express their thoughts. In my assessment, medicine teaches and reinforces the hierarchy of the patient and provider relationship, preferring that the provider maintain some level of distance that does not include an expression of our own humanity. This never sat well with me and Dr Nadine's scientifically backed information set me free to craft my own bedside manner style that aligned deeply with my values. If I only have 15 minutes with a family, I will make the most out of that precious time by showing up genuinely and lovingly to the best of my ability.
Since empowering kids is a broad scope, multifactorial process that requires innovation on multiple levels to be effective and encompassing, I feel we must go beyond the personal interactions with our patients and think on the community level also. In preparation for this summer, our department anti-racism working group, Pedi POWER, carefully crafted kits for children of all ages with valuable resources to reinforce what we felt ALL children should have equitable access to during the longest vacation of the year. The message behind these kits was purposeful: your pediatrician believes that good health is not merely the absence of disease, but the presence of ingredients that cultivate whole individuals. These ingredients hopefully allow children exposed to multiple ACEs the opportunity to interact with other supportive adults and expand their safety network. I hope you enjoy reading about the components of the summer kit below in the recommendations this month.
Medicine today feels incredibly machine-like, automating all its providers to work harder, faster and more efficiently at the expense of the patient relationship, otherwise known as the “art and heart” of our jobs. As someone who cares deeply for that illustrious combination of the art and the heart, the stories and the connection, I push back against the boundaries that prevent physicians from physically and philosophically laying healing hands on people. While I continue to think deeply and create change within the upstream causes of inequitable healthcare, many of which we have discussed at length in all our previous newsletters, I also think broadly and creatively of how to best fortify that metaphorical band aid in real time for kids from marginalized and minoritized communities.
May you all have a beautiful beginning to your summer.
In solidarity,
Amna
