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What's a "Leadiatrician?" And How to Become One · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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I'm Holly Wayment, and this is Pediatrics Now, cases, updates,
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and discussions for the busy pediatric practitioner.
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Click on the link in this podcast for free credit that may include CME,
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MOC, or ethics credit, depending on our topic or podcast.
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I'm so excited today because joining me here in the podcast studio is Dr.
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Lewis First. He is chief of the Department of Pediatrics at University of Vermont.
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He's chief of his children's hospital, and he's the chief editor for the prestigious
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American Academy of Pediatrics medical journal, Pediatrics.
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Lots of chiefs there. Holly, first of all, it is a pleasure to be here.
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And what you didn't say is that I'm a general pediatrician who,
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for the past three-plus decades, actually four-plus decades,
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has been passionate about caring for children and making a difference.
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I loved your Grand Rounds talk this morning and how you really like to talk
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about and stress the importance of caring. I think caring is an anchor point.
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This morning, I had the opportunity to talk about medical education as a lifesaver
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for our field of pediatrics.
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And when I talk about education, it's not just education of pediatricians or education of students.
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It's education of families, something that pediatricians do each and every day.
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And I presented pediatrics right now as a fairly medical education as a patient
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who had a number of maladies, illnesses that we needed to save.
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And the way we save it is by figuring out how we can better care for our children
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and families, better care for each other, better care for our patients,
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and care about the importance of teaching.
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And when we lose that and we lose that joy of seeing knowledge imparted and making that next step.
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Provider feel that next clinician feel empowered
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with a family to make a difference and take
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the education they learned and pay it forward there's nothing
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better than that so throughout my entire career i have made sure that i am not
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so distant from an administrative standpoint that i don't forget the importance
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of caring on the front lines caring for that patient caring for community caring
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for this country in the world i know that sounds very cliche but it's very real
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and we need this more than ever.
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And it starts by having a joy for how we learn and how we teach others to carry
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that joy forward and make a difference in the lives of children.
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And Dr. First, may I call you Lewis? Sure.
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So, Lewis, you say, and with all of this experience and everything you're doing,
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you feel like you're just getting started because you love it so much?
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Yes. I mean, the beauty of what we do in pediatrics is that there is not a day I can I can remember.
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I graduated medical school in 1843. No, in 1980. And so you take it.
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That's a number of years, okay, since I graduated med school.
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I cannot think of a day professionally where a difference has not been made,
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not necessarily by me, but by someone who crosses where there's a collaboration
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or I've taught somebody to make that difference in a given day.
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Or they've taught me to make a difference in a given day.
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Or I've taught a child to teach another child how to make a difference in a given day.
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I think when we look at our field nowadays of pediatrics, when we look at medicine,
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we're losing our North Star.
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And I bring this forward that for anybody listening to this podcast.
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I really hope that they stop for a minute and reflect about the moment they
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got admitted to – they applied and got admitted to a medical school,
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the moment they got into a residency program,
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the moment they got their specialty training opportunity.
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If you're a nurse, if you are someone in the healthcare field,
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or even if you are not medical, the moment you got your first reporting opportunity.
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There's this feel, there's this sense of, wow, I've gotten to this point and
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it is so exciting because I'm going to help people make a difference.
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And the problem – so I always tell my learners to just stop for a minute and
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think about that feeling and then package that feeling.
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Put that feeling in a box and put that box right next to you and carry it with
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you always because it's tough right now. There are so many challenges we face in health care.
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There are challenges with access challenges with how health reform is working or not working.
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There are so many families who can't get access to what we need and everybody
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wants services and it causes, I hate the word, the burnout.
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But if you stop for a minute, and instead of seeing the cup as half empty,
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or that there's no cup at all, focus on the importance of that feeling in that box.
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That means that you care. And no matter what happens, nobody gets up in the
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morning to do a child a disservice. But holding on to that joy,
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that feeling, that exuberance of caring and making a difference really transcends
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all of the bad feelings people have right now.
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I think when people are just focused on the dollars and the cents and the bureaucracy
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that is healthcare today,
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they forget that moment in the box, that feeling that to me has kept me going
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since 1980 and even before that when I decided to enter medicine.
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And I really hope that people don't lose that sense of caring.
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And it's all the technology the artificial intelligence people
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we're doing this face to face right now and that
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is so much better than doing this on a
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screen behind a box or with people turning the screens turn your cameras on
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let people see see your face are you having a good day or a bad day are you
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having a day where you really need that virtual hug if you can't be there in
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person i know this sounds very very what dinosaur did i fall off on but i i
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work with all generations.
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And I have watched our trainees and our senior faculty and pediatricians and
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nurses throughout our state stay there because we care.
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We are who these children have and these children have us.
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And when you can take that potential of caring and unleash it,
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then people will care about us and say, I want you to take care of my child
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rather than will I have a job?
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Will we be able to afford the vaccines in our office?
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We need to do a much better job working with our families, empowering each other.
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To teach each other, to listen to each other, and to care.
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And so my remarks this morning used education as a platform,
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but underneath that joy of teaching and learning is a joy of caring.
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And we lose that, then we lose new information.
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All of the discoverers and investigators you interview on this podcast had to
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learn it somewhere and had to get excited about it.
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And if you lose that excitement, who's going to be here to take care of our children?
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Who's going to want to do it? Who's going to remember that joy that's in that box that's next to you?
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So I'm not trying to be Pollyannish, and I am trying to recognize the difficulties we all face nowadays.
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But I would never want to be in a different specialty. I would never want to
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be doing something different than I'm doing.
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And I can't think of a profession that is an investment in the future,
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and it starts with education and caring.
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And I like what Sandy Chung, who we interviewed a few weeks ago,
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where she says the percentage of
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children, I think she said 25% of the population, but 100% of the future.
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And how amazing to be caring for the future. Sure.
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It's a great quote. But also, don't feel like we also, this is not martyring yourself.
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This is about having lives and wellness and taking care of each other.
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So that's a wonderful quote from Dr. Chong. I will remember that.
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But I also need to say that this is a partnership.
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This is using the communities we live in. It's getting out there.
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One of my, I don't know, things that drive me is visibility is credibility.
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And if you find yourself always in the same professional environment,
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in that office all the time, in that operating room, on that inpatient floor,
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in that laboratory, you're missing, you're in a tree and missing the forest.
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One of the things I ask the members of our department to do is to tell me each
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year, what have they done to improve the communities they live in,
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to embed themselves in the community and show and learn from those communities?
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When you say I've got something that I've got a treatment that will help your
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child, can they afford that medication? Do they know where to get that medication?
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Is the medication explainable? Do they understand how to give it?
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It could be as simple as a behavioral issue, but to listen first and not just say I can help you.
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So families are listening to this.
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I hope that they will feel empowered to teach us.
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One of the things I get to do, like you get to do in Vermont,
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where I come from, is I give pointers on health tips on radio,
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television, and newspapers.
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But the joy I get is when people write back and say, I've got a better tip to
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get your child to stay in bed.
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I've got a better tip to get the room cleaned up.
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And I go, wow, I never thought of that.
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So they're teaching me. And I really hope that families know we can't do this
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without putting the child in the center who can teach us all and then partnering
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to realize the sum of the parts better than what anybody else can do.
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So what you're saying, Dr.
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First, is it's important for families to speak up and also for the pediatrician
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at the same time by that listening,
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then that can help remind everyone why we got in this in the first place.
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And then also you're learning from the patient. Absolutely.
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One of the things we have done with the journal Pediatrics is we've created
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a section called Family Partnerships.
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I know we're getting away from it, but it is education. I said we're getting
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away from education, but we're not.
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This is a column that I put together, that we put together, that are articles
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written by families with their pediatricians.
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And specifically, we make sure that both voices are literally quoted.
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It's like a play. You can see here are comments made by that family member of
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not, I had a good experience, bad experience.
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I love my pediatrician. That's not the goal of the column.
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The goal is to say together we made a difference in our community.
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Together we started a new program. Together, we changed what the office would
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look like so that families of all races.
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Ethnicities, gender fluid disabilities could feel welcome by empowering families
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to say, let's do this together and make this our project.
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And we make those articles free. I mean, we don't say you got to pay.
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I put them out there. As soon as you click and go family partnership,
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you'll see these articles where families and pediatricians together make something better.
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So that to me is learning and teaching in action.
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And I love the fact it's unconventional for a journal to put in something.
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No, that's not necessarily going to be in everybody's scientific studies, but it's what we do.
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It's what we need to do. If it's suddenly I'm the pediatrician and you're not,
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and I'll tell you what to do for your child.
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I hope that model doesn't exist. Once upon a time it did. But we're doing children
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a disservice if we're not listening to families.
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I really hope families will take articles. We actually have family public members
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who take our articles and they just rewrite them so that families can walk into
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their pediatrician offices and say, have you seen this?
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When I hear from families saying, I took that article to my pediatrician and
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they're doing that now, how can you not smile and feel like it wasn't my study,
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I didn't create that discovery,
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but a family member took it to their pediatrician who now did it because they
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were too busy to read the journal, which is why many people are.
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But now that message is being taught by a family to a pediatrician.
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In the same way that I hope pediatricians teach it to families,
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but it's not a hierarchy. It's a collaboration.
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I love that. And so we'll put in the text for this podcast, the website for
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the journal Pediatrics.
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And then so you click on there. It's the family partnership.
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Yeah. And there's also a blog. Again, we have families who are part of our editorial
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board that we have. We don't we are.
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I don't it's a it's a journal that is I always talk about it as our journal. It's not mine.
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I get very uptight when you say, well, as an editor, what do you think is the future of children?
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I am not. How can I have that expertise?
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Without listening and asking you the same question back. Together,
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we try and figure out what children need.
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But for me to pontificate because I wear this mantle of being an editor, it's collaborative.
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We, every weekend, have on our phone calls to pick articles.
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Families join us.
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I'm just saying it's much more than a, I like this, I don't like this.
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It's got to be a collaborative process of what goes in the journal, who puts it together.
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We have a blog that families write for each other. I know we're talking a lot
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about families. We also have blogs that are written by pediatricians to say,
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here's why this article is important.
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And so I look for different ways to teach. To be honest with you,
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when we talk about medicine and education, the office is not the only place
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to learn how to basically improve the health and well-being of children.
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Children are rarely in your office.
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So you say, where are they? Well, they're in schools.
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Do pediatricians write a column for the local PTA school newspaper?
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Do they do an open forum question and answer? Do they do that?
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I've been the safety officer for the Little League in Burlington.
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And when I sit on the bleachers, people ask me questions.
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And I ask them two questions to make sure people stop me on the streets to say,
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look, we're wearing the helmet or look, the backpack has just the right amount of weight in it.
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They would not know this. It's not because I have time in the office to do it,
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but I've used other platforms to educate.
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I'm on the country music radio station in Burlington. Do you like country music?
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Before I did this, I knew nothing. Here's a great example. I was overheard doing
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a public affairs show on a year after I'd been in Vermont on the future of children in Vermont.
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And I was told it plays in the milking barns of Vermont at four o'clock in the
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morning, the show would air.
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And so I said, gee, the milking barns.
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So when they started the show, I said, well, I said, this is going to be a moving experience.
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I don't want to be a coward, but let me milk the issue of children.
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And the host was just looking at me saying, I can't believe you're saying these things.
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When it was over, two guys were at the door of the booth we were taping in,
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and they said, do you know who we are?
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And I said, I don't know who you are. And they said, we're the morning roundup.
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I said, the morning roundup. They said, yeah, we're the morning show on the country station.
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We were in our studio. We're in our station. Do you know anything about country music?
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And I, you have to, honesty is the best policy. I said, I know nothing about country music.
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To which they said, well, we know nothing about pediatrics. So let's make a deal.
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We're going to teach you about country music. And you're going to teach us and
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our families about child health.
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And we're going to have a good time doing it. And for the past 25 plus years,
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I have been on every week on the morning show.
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And I love country music. The answer is that you don't lock and load,
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but I love, I go to the concert.
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I do too. And I'm here to say I have enormous respect for the musicians,
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for the music, some of the lyrics.
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It's good that I know the lyrics because I can then talk with our patients and
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with communities and with kids about what they're taking from those lyrics.
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But if I didn't know that, I would have missed an entire angle.
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And this is not just for country music. I will spend a lot of time as a teacher
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doing the pre-work of where am I going? One size doesn't fit all.
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If you listen to my Grand Rounds this morning, it was very San Antonio specific.
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And I had to learn that because it may not what we do in Vermont work in San
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Antonio. And yet, credit goes, I learned a ton about the great educational opportunities
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for health, for training that you have here.
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And so my hat went off and I saluted San Antonio this morning because I learned
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a ton about the great things that are going on here in the department,
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at the Children's Hospital, at Long.
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Yeah, the long, you're talking about the long school of medicine. Yeah, sorry.
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And I'm here, I know this gets to other people who are listening,
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but the truth is I look for the strengths.
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My goal here is not to come in and say, this is Vermont and you're not.
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It was to say, you have some things, we have some things, but most importantly,
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we have this passion to teach.
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And here's how you are helping to change the world, make it a better place.
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And so when we do that, we healed the patient.
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Our sick patient medical education, I hope when people went out,
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they were inspired this morning to remember the joy of caring and how you get
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to caring through education.
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And that summed it up. Yes. And back to that box, and we're thinking of why
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we got into what we're doing in the first place.
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Is it important to also think of something that inspired you or something you did really well?
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Well, or like in my case as a journalist,
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I helped uncover there was a serial ski mask rapist from San Antonio,
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the most notorious rapist in the world at the time who got a controversial treatment,
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was sent to the East Coast.
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I looked into the case like 15 years later and I found him and he was on the East Coast.
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There was a serial rapist there, the Bandana Bandit. Basically,
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he had switched his headgear, had not spent a day in prison.
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Now he has the maximum. He's behind bars. Joseph Frank Smith is the case.
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But basically, that feeling of like, this is why I became a journalist.
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That's it. But you said it's not the thing. It's the feeling.
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I think the thing, unfortunately, is you did it and it's done.
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But you have to hold that feeling. I got into medical school.
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I solved the case. You know, I report I got lauded for uncovering a story.
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And then you go, well, now he's behind bars. Now he's behind bars.
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So now what? And instead, it's how did I feel when I did that?
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And what do I need to do to capture that?
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And if you don't incorporate lifelong learning and a joy of caring for children,
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even if I'm not directly responsible for a child, I walk our children's hospital repeatedly.
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Repeatedly, I look in the morning of who got admitted, just to have my finger
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on the pulse of knowing these are not just numbers on a computer screen.
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These are children and families who have had to come in when they didn't want
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to into the hospital or come for an appointment.
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So let me put myself into their shoes. And they might be scared.
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They're going to be scared and think, what can we do to humanize this experience?
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What can we do to humanize this experience for each other?
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I made a comment, I did a workshop yesterday on how to become clinical teacher
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of the year but simple things for example, when a learner comes to meet you just sitting down,
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For one, I always talk about the importance of the first two to three minutes
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that you meet somebody new or how you greet a family.
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If you sit down, if you focus on the child or in this case, focus on the learner
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and not just follow me, we're going to go see the next patient.
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It tells that learner that you care. It tells that learner that you're stopping
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the action to recognize they are in your area or you're visiting with them and
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to make sure that they know that this is sacred space in the sense that together
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we're going to try and make a difference.
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And so would you say the same to a lot of our listeners or community pediatric
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practitioners sitting with the patient at eye level?
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Yes. Oh, for sure. I think I hope most of you, if not all your listeners know,
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don't look at that screen or if you're looking at it, look at it together. other.
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But do what you can do. Here's a situation where artificial intelligence is
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now coming into offices where you don't have to look at that screen.
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It's all being recorded for you. And you know what you can do?
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You can look right at the family and have a conversation like you and I are doing right now.
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Not looking at notes, basically just talking about what we feel and what makes
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sense when we're trying to build some passion.
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And apparently AI can even knows to, it doesn't keep the small talk,
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but keeps the clinical notes. That's fine for AI, but most importantly,
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you know, that's small talk.
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Making a comment, okay, about the toy that was brought in.
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Being able to say, I made the comment this morning that I showed three slides
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of a pediatrician talking to a family back in the day when there were no computers.
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And then a slide of me talking to a family where there's images and there's a monitor next to us.
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And then one where I'm talking to a family that's in the monitor.
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And I made the point that I'm in Vermont, they're in San Antonio or they're in Texas.
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And for me to tell that family, you know, how to bring up their child or what
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they need to do is it's like asking me to be an Olympic athlete while we're
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taping this, the Olympics are going on when I don't have the child.
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I have no expertise there and I shouldn't. Despite my training,
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I do not know what the kids of San Antonio need to hear from their child health care professional.
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And that's the beauty of using AI to the side to save some time to enable you
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to build a relationship,
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a relationship that builds with each visit that says that is my doctor,
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that is my nurse, that is my receptionist who has a smile on their face when
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they greet me because they've seen me at multiple points in the line.
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And not just this is patient number 225.
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You know, this is the 10 o'clock who's going into room seven. We never say that.
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Think about it when you're a patient. Think about when you're put in that room
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and the door closed and you're waiting. They're in there and they're anxious.
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So we need that small talk. Even if it doesn't make the AI, it says we care.
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And there's a way to do that, to have the time now with AI, to be able to figure out.
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I want every patient to feel like they are my only patient.
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And I hope, and that's the special moment. It doesn't mean you're there for hours,
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but you you can you can personalize a
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baby with a diaper rash i'm not here to trivialize diaper
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right but but in a way that that family says boy i
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thought i i was going to bother the doctor you never much rather
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be upstream and have a family feel comfortable to
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ask what is ever the question is going to be then feel
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like i don't want to bother them and go to dr google i'm not
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here to and and get advice that again is like being behind
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a screen they don't know that family I was with
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the pediatrician the other day with my three children and that pediatrician
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incredibly personable all the things that
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you're saying the appointment was great but the medical assistant
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before then her back was turned to us most of the time I don't think there was
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ever eye contact the questions like the 20 or maybe 15 minutes spent with the
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medical assistant before the doctor walked in it was the opposite of the way that he talked so
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How important is it for the staff to be trained and to know,
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you know, that connecting,
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you know, like even asking like my, you know, asking my children and back turn
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to us, are all your grandparents still alive?
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You know, like, and it's like, yes, but what if, you know, it's like,
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that's a sensitive question.
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And it didn't seem like she cared as she was saying it. Maybe she did.
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It just didn't come across that way. Okay.
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So you're so spot on about this is not about just being a doctor. I'm a doctor.
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I'm proud to be a pediatrician. I will tell you. I'm sure Dr.
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Chung, I'm sure all your guests, but I don't flaunt that.
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Okay. It works because I'm proud to be part of a team and you're only as strong as your weakest link.
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One of the things I teach in teaching is the importance of day one.
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And that's not day one for a medical student.
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It's day one for how your office operates. If If somebody's coming into your
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office to join your team, then you need to take as much time with that person
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versus, oh, this is this is.
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Whoever it is, this is Holly. She's going to be our new receptionist.
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This is Bob. He's going to be our new receptionist. Oh, hi, Bob.
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And then you go off. Stop.
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Take the time to bring Holly or Bob into your office or sit down with them right
25:02
there and tell them how valuable they are going to be, how important it is.
25:07
I ask when I work with medical students, I tell them they're going to spend
25:10
time with the front desk.
25:11
This is the front line for your patients. This is how families access the practice. They feel valued.
25:17
They should feel valued. They're critical.
25:20
I tell our medical students when they go on a floor, introduce yourself to the
25:23
person who is at the front desk.
25:26
Introduce yourself to them. I have our nurses teaching our medical students.
25:29
Make sure people know you're going to be taught by everybody and learn.
25:33
How do the phones get answered? When people suddenly realize,
25:36
I love spending time with nurses.
25:37
I love spending time with respiratory therapists, with all kinds of healthcare personnel.
25:42
It's not because they are part of the team.
25:46
I hold committee meetings at our hospital with all of the services that are
25:51
not directly in my line of pay, from pastoral care to pharmacy.
25:55
You see, they all come together and we talk about children and they say,
25:59
this is so special that we're all together having this conversation and they're
26:03
learning from each other.
26:04
So the answer is interprofessional care is critical.
26:08
Interprofessional care with families is critical. Doing it with your school
26:11
teachers, doing it with after school activities, getting to the coaches who
26:15
are out there with sports.
26:16
How are they talking health? What's their philosophy of leadership,
26:20
coaching and empowerment for kids?
26:22
How many people find strengths in what they do? Two, can a nursing assistant
26:25
stop by saying, that T-shirt is the greatest thing I've seen.
26:29
Wait till I show Dr. First that T-shirt. He's going to fall over.
26:33
Noticing something about the person in front of you. Always.
26:36
It's like a peace offering, but it's genuine. I'm interested.
26:39
And if children come and the T-shirt is ragged, we need to ask every question.
26:45
You can't judge a book by its cover.
26:48
And we know that in terms of food insecurity, housing insecurity.
26:52
These are critical issues. issues, but don't open the box unless you know what to do.
26:56
And if you don't know anything about housing insecurity or food insecurity,
27:00
it's time for education because this becomes as important a part as saying,
27:04
I'm going to write you a prescription for whatever the medication is that's
27:07
going to treat the fever or whatever it's going to be.
27:09
Hopefully we're not ever doing antibiotics folks, but, but you understand it's
27:13
in the context of, can you even afford this?
27:17
What are your child's interests? We have a whole system in our hospital.
27:20
Our nurses are empowered to ask every family about sensory issues for children.
27:26
What do their children, what's their favorite touch? What's their favorite sound?
27:30
What kind of music? What colors?
27:32
And then they will work to make sure on the door of each room with permission
27:37
of the family. We know that.
27:39
So we bring in the touch, the textures, the things that make that child feel
27:44
like you're taking care of me. and not every child gets the same approach.
27:49
And I will tell you, the nursing assistants, they love this.
27:53
They love asking those questions because they know when they get that information,
27:57
we're going to learn from what they got to make that experience for that family
28:01
incredibly important and to empower that family to say, they're not going to understand my child.
28:06
I know my child better than anybody else. And they do.
28:08
And now they're saying, my God, they're even bringing in a type of blanket that
28:12
really works as opposed to here's the company blanket.
28:16
And is there one thing you would recommend in addition to what you just said
28:20
that pediatric practitioners can do today to empower their staff to show that customer service?
28:25
Should they know that they'll sometimes be observed or is it more of each day
28:30
saying something to the team about? So there's a long game and a short game.
28:34
I love it that there are huddles at the start of a day.
28:38
I do a huddle with my department and I'll be honest with you.
28:40
We always salute. We start our meetings with appreciative gratitude. attitude.
28:44
We always find, it could be somebody's birthday. It could be somebody got $2
28:48
in the lottery last night.
28:49
It could be somebody tried, but we will, somebody's child, you know,
28:54
did something, scored a goal in a soccer game.
28:57
And then we salute what national day of the, you know, their national days.
29:01
Two days ago, I just remember it was National Preposterous Packaging Day.
29:05
Oh, I didn't know there was such a thing. When you have bubble wrap on top of
29:08
bubble, but the point being we stop and start with something Something that's
29:11
not directly, you know, we have a busy day, but just saying,
29:14
does anybody want to share?
29:16
It takes a second to do that. That's the short game. That's each day starting
29:20
it off to say, you know, did anybody watch the Olympics last night?
29:24
Okay, what did you think? You know, we discuss it.
29:27
The long game is when somebody comes into your unit, your office,
29:31
your place of work to not miss the first five minutes and to share the joy and
29:37
the culture that you want that office to operate by.
29:40
Even though you have an office manager who's going to say, this is how we do.
29:43
This is where you hang up your coat. This is where the bathroom is.
29:45
You want somebody to say, you're in a very special place and you make it that way.
29:51
And it's because of the, you know, this is, this is so energizing. You miss that.
29:55
And people decide, let's look at, let's look at using Teams or Zoom,
30:00
or I don't mean to use a brand of a, of a telehealth kind of thing,
30:03
but people turn off their cameras.
30:05
You have a conference call and people are just cameras off and somebody's speaking.
30:10
You miss it so do you say at the start I want all cameras on unless there is
30:14
a truly extenuating circumstance and you miss it.
30:17
I want to see you. If you can't be here in person, let's look at each other.
30:21
Let's do that. I used to do contests during COVID to keep everybody interested.
30:25
Pick your favorite work of art, your favorite painting, and make it your background.
30:28
Okay? Your favorite food, your favorite sports team, your favorite music,
30:32
an artist, your favorite cover album.
30:34
That's a great idea. So everybody would come on to the calls,
30:37
and people look forward to turning on the cameras, not to, you know,
30:41
to see what they did with their backgrounds.
30:44
But it builds a team. And then people say, these are fun meetings.
30:48
Let's do this. And so if you miss that, then the habits are set.
30:53
I tell people, if you're eating your lunch, we're not going to look at you chewing your food.
30:59
But just if you want to turn it off while you eat your sandwich,
31:01
that's up to you, but you're with friends.
31:04
But doing that advanced work and thinking about the importance of day one in
31:08
the long term for your site of practice, I tell trainees or residents taking
31:12
over teams for the month, how do you want your team to run that month?
31:15
The way it was run for you or now you're in charge?
31:18
Do you set up a game for them? Do you set up something to energize people?
31:22
We have food Fridays and they pick a theme and everybody gets excited about
31:26
food Friday where you bring in, pick a country, pick a day.
31:30
But if you don't do that and create that environment, then it's another day at the office.
31:35
And it should be a special day, but it's just that you got to make that another
31:38
day at office. It's another great day to be a part of wherever I'm working.
31:42
And as a pediatrician, that's what I'm trying to get people to remember.
31:46
And I was at an orthodontist's office where the head of the clinic,
31:52
the orthodontist, he said that every morning they gather together as a team.
31:57
They set the tone for the day, what their mission is. And he said sometimes they even join hands.
32:04
A huddle, you know, a pep rally. Look at athletic teams in the locker room before
32:07
they go out onto the court.
32:09
It's energy. It's a feeling. It's capturing that feeling.
32:15
It's infectious. It is infectious. But when you learn something new and you
32:19
can show someone else how to do that, that to me is the joy of pediatrics.
32:23
We are teaching young people to pay it forward decades from now.
32:27
Now, okay, we're teaching medical students.
32:29
If you take that amount of time with a medical student, my hope is that no matter
32:34
how busy they are as their life advances, they remember the time we took to
32:37
make them the best doctor possible and they're going to then want to pay it
32:40
forward to someone else.
32:41
It's also a solution for if you're in a rural area, if you are it,
32:46
meaning, and God bless you if you are, you need sustainability.
32:51
Who's coming next? Next, so to figure out how do I bring somebody to my office,
32:56
not slow us down, but show them this community, this rural community,
33:00
and how special the people are that we see.
33:03
This has been a secret sauce in Vermont, that we use all of our rural offices
33:07
and they open their doors to learners.
33:09
It energizes them to learn new material, and it then shows learners parts of
33:14
our state that they would never get to, to realize the heart that people play
33:19
with and what people do to make that difference. And the box gets bigger.
33:23
That box of that inspiration of why I want to do this is to help these people who care.
33:28
I've stayed in Vermont 31 years, not because I don't get to see places like
33:33
San Antonio, which come to the city, and I grew up in a city, but I know the fate.
33:39
I mean, to look at the faces of the people we care for in our state and not
33:43
to care and say we need to be here for these kids is why every day I'm still
33:49
doing this 31 years as a department chair and feeling like I just got started.
33:54
So I interviewed one of our pediatric emergency medicine doctors last week for our episode.
34:01
You can check in the Pediatrics Now news feed.
34:04
Our listeners, if you haven't heard that yet, it's about the accidents they've
34:07
been seeing in the ER this summer and heat health.
34:11
But this has been a real, I was joking to everybody.
34:13
It's like being in Vermont right now. Yesterday was 109.
34:16
Really? We do see a variety of seasons, but it's important for me to understand
34:22
too. That being said, I am on television talking about still children.
34:27
We do have heat in Vermont and children can be left in cars.
34:32
And this is a horrible thing.
34:35
And she talked about it's horrible. And she talks about preventive ways to help
34:42
that not to happen. To leave something in the back seat. No one thinks that's
34:44
going to happen, really.
34:45
But she says what inspired her is she loves that feeling of I helped today. Ah, there you go.
34:52
And how often do you recommend that we go back to that memory box?
34:57
Do you do it several times a day, once a day?
35:00
Whenever something goes less than positive, and it does, then how do you do
35:06
your summit up at the end of the day when you do your checks and balances?
35:10
If you finish each day saying, I got yelled at by four families,
35:14
nothing could go right, I ran behind, wasn't there.
35:17
Well, why did you run behind? it's because you took time with
35:20
one family who you felt needed your time and
35:23
they may not be the ones that say thank you but you go that's why I'm doing
35:26
this and so if everybody listening just realizes that families and families
35:31
too that nobody wakes up in the morning to do your child a disservice nobody
35:36
and so if an office is running late this is again this is a learning experience
35:40
put for families listening if they happen to be.
35:43
Put yourself in the shoes of the doctors and nurses okay,
35:46
and say, what are they experiencing, trying to make every one of these children
35:49
feel like they're the only ones in the world?
35:51
And if they're not seeing me, they clearly had something that required some
35:55
attention and they will get to me. And the answer is they will.
35:59
It's so true. And then at the same point, is it important for office clinical
36:04
staff to let the patient know we're running behind?
36:06
Kind of get an estimate. Beyond, be transparent.
36:09
Talk about it. Families have told me when they are left in a room,
36:12
we'll be right back, okay?
36:14
Now there's a child having an asthma episode. and they need attention.
36:18
Well, you can't go back in and say, little Billy's in the next room having an
36:22
accident. So you can't tell that family that.
36:24
But somebody from the staff should say, Dr. First, it's an emergency.
36:28
We apologize and be cognizant. They've been in a room for how long before someone
36:33
has come in? And again, they're nervous. And they're nervous.
36:36
I've seen families start to call relatives for something not very major because
36:41
the doctor didn't come back.
36:43
And they say, uh-oh, they're clearly, this is bad. and the doctor didn't come
36:47
back because it may even be their family called and said, we have a family emergency.
36:52
Just not to share that, but tell people what's going on or tell them it may
36:56
be 10 minutes, but we care.
36:58
This is because we're trying to get to everybody, but we want to give you the
37:02
time you need. It shows respect.
37:04
It shows respect. And if a family, I'm very sympathetic. When families are late,
37:09
we need to put our, the learning point is why?
37:12
Did we not, was it clear? What's public transportation doing?
37:16
Were there problems? Is parking a problem?
37:19
What can we do? Do we need to think about that family next time to recognize
37:23
it's going to take them longer to get the office rather than they waited that
37:26
long for the appointment?
37:28
And now they come late and they're told, sorry, we can't see you today.
37:32
The answer is we tried and make that room. We may not cover everything.
37:36
But to get mad only just makes it more difficult the next time you see that
37:41
family to get that child and family to do something proactively for their children
37:45
when they think all you're looking for is your own efficiency.
37:49
And, you know, I want to get out of here by five o'clock. I'm not saying you
37:52
can do this, but if it means staying an extra couple of minutes.
37:57
Pull that box out. And remember, this is why we do it.
38:00
And if it happens consistently, what can we do in the office to speed things
38:04
up? Do we start appointments earlier?
38:05
Do I end the day earlier so I can get out by 5 o'clock?
38:08
But let's not take it out on families. And let's not have families take it out on us.
38:13
And sadly, which is, you know, healthcare-associated violence right now is peaking.
38:18
I mean, it's really bad, Holly.
38:20
The nice thing about pediatrics is we listen. So families are angry, and we're right there.
38:25
Care and so they vest it you know they don't know what to
38:27
do so they turn to us and so this is
38:30
a learning point how do we de-escalate that how do
38:33
we show that our offices are safe places how do we show that we care and when
38:38
it's quickly like you're late you didn't get here why wouldn't they be angry
38:42
then you leave them waiting or then you say we can't see you you're adding a
38:46
lot of aggravation to what should be a very joyful moment where they may actually
38:50
lean into that vaccine scene where they were a little hesitant.
38:52
They may lean into doing the right things in terms of safety prevention or remember
38:57
to put something in the back seat of the car so it doesn't, they forget that
39:00
their child's sleeping in the sleeper.
39:02
A person at the front office staff and patients were waiting a long time and
39:07
I just, I asked her, or why didn't you mention to the patients that the doctor's running behind?
39:13
And she said, well, I don't know how far behind, so I don't want to say the wrong thing.
39:17
But really, if that person's empowered to say something and say,
39:21
I'm not, I don't know how long, but so sorry, but she's running late.
39:26
It's okay to say, you know, we are, we are so sorry,
39:29
but we're not trying to delay this visit, but there are, and your child has
39:34
just as much, needs as much attention as anybody that's already in a room,
39:37
but we need to take care of each patient and we will take care of you.
39:42
And, And hopefully we will learn from you just as you will learn from us.
39:45
So it's a philosophy. And it starts by, again, going back to the feeling,
39:50
not the I did a great story of what do we want to do to inspire those we work
39:56
with and to inspire ourselves to come back in the next day and say,
39:59
as good as yesterday was, today is going to be even better.
40:03
You talk, Lewis, about being a leadiatrician and being present.
40:07
Can you tell us more about that?
40:10
I think whether everybody who cares about children, to me, is a leadiatrician.
40:16
And to be a leadiatrician, it really means that you hold to certain tenets.
40:22
And I'll share the ones that I think are important.
40:25
Number one is visibility is credibility.
40:28
Get out in the community.
40:30
Circulate. Not because you're standing there to do blood pressure checks, but volunteer.
40:36
Volunteer to Foo Show. Coach, mentor, perform for whatever your religion.
40:41
Get involved in something where people see you as a human being.
40:44
And when they see you as a human being caring about your community,
40:47
they will also pay more attention to what you're trying to do to care about their child.
40:51
Number two is to communicate and have the right, you know, invite everybody
40:57
into the tent by doing what we talked about earlier, you know,
41:00
sharing a message of joy of what you're there to do. Get the right people on your team.
41:06
If people don't want to do this, don't force them to do it. I don't sit there
41:11
and solicit. People who want to be pediatricians come to me.
41:14
I'm in medical school. I don't stand in the hallway and say,
41:16
hey, you know, want a sticker?
41:18
You can be a pediatrician. That's not it. They need to feel.
41:21
When they're there, we surround them, but I want them to feel it first.
41:24
So if they're not feeling, I don't want people in pediatrics who don't want
41:27
to be there, but when they're there, sometimes I'll rearrange.
41:29
People can change their mind, but you need to communicate, communicate frequently
41:35
and communicate across the board.
41:37
That's an important piece of being a pediatrician and not just to say I know
41:41
and you don't the third thing is to sometimes take risks.
41:44
Where it aligns with what you think is going to make a difference okay I have
41:49
done some things even getting involved with,
41:52
country radio where I'd never done it the safer point I don't do radio I don't
41:57
know anything about it if you think you're going to get your message to kids across.
42:01
By going to a forum or speaking in a school group that you've never done, take the risk.
42:07
You'll be surprised. They want you to succeed. You don't have to be a public speaker.
42:11
You can write a column. Just, you know, if you've never coached,
42:14
take the risk where you can interface with your community and it makes you a lead attrition.
42:20
Not in any order, but play with heart. It is really important to celebrate the
42:25
positives as much as possible.
42:28
So as I said, in our department, in everything I do, we have appreciative,
42:32
like parents, As parents, we always, parents are always looking for the hole
42:37
that our child trips and falls into.
42:39
But when they do the right thing, when they actually put their clothes in the
42:42
laundry hamper, or when they cleaned up their, or they made their bed,
42:45
or they brushed their teeth, celebrate that.
42:48
Okay, celebrate that. When I started, I used to have everybody in early months
42:53
until my kids got a little bit older over to the house on their birthday months.
42:57
And you could bring whoever you wanted to bring, your kids, family, partner.
43:00
If they were alone, they were welcome to create an environment where it was safe.
43:05
You wouldn't bring who over on their birthday month? Members of our residents
43:09
and our faculty and our nurses.
43:11
Now my kids are at home, they have homework to do. So we didn't quite do it, and we got bigger.
43:15
But in the beginning, it allowed them to see my family or who was in my life,
43:20
and for me to see, do they have supports?
43:22
Don't they? and let's make sure everybody feels valued that you don't have,
43:26
they don't have children that doesn't make them, they could be phenomenal pediatricians,
43:30
but it's important. They don't have a pet.
43:32
Okay, you can bring your pet, but find opportunities to get everybody together.
43:38
Playing with heart in our department, we have our cells divided like Harry Potter houses.
43:42
And every month, our chief resident asks us to take pictures of things,
43:47
selfies, doing wellness activities.
43:49
And we show them at our morning meetings, such as try a new restaurant,
43:53
take a hike, go to the dentist, read a book, see something, you know,
43:58
binge something on TV and tell us about it.
44:01
And you see these smiling faces and you see dogs and cats and people dressed
44:06
up in costume and members, you know, having off campus, swimming,
44:10
doing things and you smile.
44:13
And so we play with heart. There was a paper in pediatrics by Dr.
44:17
Steve Ludwig, who used to be program director. He's now retired at Children's
44:20
Hospital of Philadelphia. called The Polygamy of Pediatrics.
44:23
And in that paper, he describes the fact, I'm not here to preach polygamy,
44:27
everybody, listening to Holly's like it. Thank goodness.
44:29
But what we do is he says, you have three marriages in pediatrics.
44:33
You have marriage to people who love you and that you love.
44:37
You have marriage to your career and marriage to things you like to do for yourself.
44:41
And rather than try to juggle those balls, where do they intersect?
44:45
So I love it in my department when people stand up and say, you know,
44:49
I performed this weekend or I had a violence or I watched one of my doctors
44:54
had their son go to the semifinals of the Little League World Series.
44:59
We had a Vermont team that made it to the New England.
45:02
And he was so proud to tell the story. They didn't make it.
45:06
But giving time in our morning report to say, I'm going to talk about Little
45:10
League is playing with heart.
45:13
And then, so I'm giving you an example, and having the selfies and doing,
45:16
finding wellness for oneself, for your department, for your division, for your office, do it.
45:20
And then finally, as a lead pediatrician, measure it. And by that, how do you know?
45:26
And so it's not that you have to, you know, how do you know that your office
45:29
is doing it? Do you have satisfaction ratings?
45:31
Do the students that you bring to your office go off and teach others?
45:35
Are our families wanting to
45:39
go with you to advocate to the legislature because they feel
45:41
together we make a difference what are your measures of
45:45
making a difference for children so that others will tell your story and pay
45:49
it forward long after you and i are not sitting here at these microphones so
45:53
when you take the visibility the communication the taking risk where something
45:58
you haven't done before that brings pediatrics out there when it's playing Playing
46:01
with heart and when you measure it,
46:03
even any one of those five puts you on the lady attrition leaderboard.
46:07
And I just hope that you don't have to be a department chair or an editor to
46:11
say you're a lady attrition. It's that you care for kids and that you want to
46:14
learn how to do it even better.
46:16
And I know you were flying around in Florida from Hurricane Debbie.
46:21
You found a way to get back, to be present, to give a talk in the morning.
46:27
So it's that joy that leads you to, and then fly here a few days later to San Antonio.
46:33
Yes, if people in Vermont are listening to this, I'm there, people.
46:36
Believe me, I am right there with you.
46:37
But they know when I am going out that I'm trying to do what we all do as teachers, is share what we do.
46:44
Yes, we have some tough days in Vermont, just like you have tough days here
46:47
in Texas and tough days in San Antonio and at Long Medical School. But, but.
46:53
We will do what it takes to be able to make that difference as long as we don't
46:59
lose track of that inspiring joy of teaching,
47:02
learning, and caring that makes us the child health
47:05
care professionals and family members and community members that say that that
47:11
sustainability of what happens next is really our ability to infuse into that
47:17
next generation people who are going to feel as excited about what we can do as pediatricians.
47:23
There's never been a better time, despite everything that's out there,
47:25
and people can write to me, to be a pediatrician. If you look at it this way,
47:28
and why you went into medicine, then if you look at it the other way,
47:32
and just say, there's nothing, nobody cares about kids. And that's what I'm trying to say.
47:37
When you talk about generations, we all face the same.
47:41
We want to be healthcare professionals who are listening to this. We want to parent.
47:46
We want to see or be on. We want to interact with children.
47:49
And that no matter what year it is, hold that.
47:53
Because if we stop holding it and let AI take over and have everybody using
47:57
the digital age and TikTok-ing their way to say, no one's talking to me,
48:01
so I'll look to the digital devices that I've got, we're going to lose.
48:05
We're going to lose. So turn your cameras on, get out there,
48:09
get in the community, lead, teach, learn, and care. And be inspired.
48:15
And then through that, you'll be inspired. Of course, with the heat here,
48:17
you can perspire too, but inspire while you perspire. I like to swim as much
48:21
as possible in the summer here.
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Dr. Lewis first. Thank you so much for being here today on Pediatrics Now.
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Thanks for having me, Holly. I hope this was fun. Again, thank you to everybody
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who listened to this because you're learning by listening to this podcast.
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You're learning by even making the effort to say, I want to be better.
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Just I want to thank everybody who is doing what they can do,
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whatever they can do, to make each day a better day for children and for themselves
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and for the communities they live in.
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Hold to that. Put it in that box. And thank you for teaching,
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learning, caring, and in turn, inspiring others, just as I hope you can find
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inspiration in what you do.
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And we have the podcast Pediatrics Now for Parents, and we'll have an episode on this as well.
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So that's our sister podcast. also meant to empower patients and cover a lot
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of the same topics that we cover here on Pediatrics Now. Terrific. That's great.
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I'm Holly Wayment. Thank you so much for listening to Pediatrics Now.
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Don't forget to click on the link in this podcast for free credit that may include
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CME, MOC, or ethics credit, depending on the topic or podcast.
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Our website is pediatricsnowpodcast.com. My email address is on there.
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Music.
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Please email me with episode ideas or comments. Thank you for listening. I'll see you next time.
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Coming up next week, I'll talk to the doctor who has created the first fully
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humanized immune system in mice.
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What does this mean for medical science, vaccines, and why is estrogen so crucial here?
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And these are the cells that will give rise, will proliferate and differentiate
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and give rise to a whole human immune system.