Pediatric Patient Quotes

The American Academy of Pediatrics officially supports breastfeeding, but receives about half a million dollars from Ross, manufacturers of Similac infant formula.

What I really don't understand is why many doctors kick patients our of their practice over this issue. What's wrong with simply disagreeing with parents but still providing medical care to their child? That's what the American Academy of Pediatrics tells us we should do. Read them the riot act once then move on and be their doctor. A family that chooses not to vaccinate still needs medical care. Sure, their child may catch a vaccine-preventable disease, and yes, their unvaccinated child decreases the local herd immunity and puts other kids at risk, but that is still their choice. Parents of patients refuse to follow my medical advice every day.

the new “affirmative-care” standard of mental health professionals is a different matter entirely. It surpasses sympathy and leaps straight to demanding that mental health professionals adopt their patients’ beliefs of being in the “wrong body.” Affirmative therapy compels therapists to endorse a falsehood: not that a teenage girl feels more comfortable presenting as a boy—but that she actually is a boy. This is not a subtle distinction, and it isn’t just a matter of humoring a patient. The whole course of appropriate treatment hinges on whether doctors view the patient as a biological girl suffering mental distress or a boy in a girl’s body. But the “affirmative-care” standard, which chooses between these diagnoses before the patient is even examined, has been adopted by nearly every medical accrediting organization. The American Medical Association, the American College of Physicians, the American Academy of Pediatrics, the American Psychological Association, and the Pediatric Endocrine Society have all endorsed “gender-affirming care” as the standard for treating patients who self-identify as “transgender” or self-diagnose as “gender dysphoric.

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Dr. Lydia Ciarallo in the Department of Pediatrics, Brown University School of Medicine, treated thirty-one asthma patients ages six to eighteen who were deteriorating on conventional treatments. One group was given magnesium sulfate and another group was given saline solution, both intravenously. At fifty minutes the magnesium group had a significantly greater percentage of improvement in lung function, and more magnesium patients than placebo patients were discharged from the emergency department and did not need hospitalization.4 Another study showed a correlation between intracellular magnesium levels and airway spasm. The investigators found that patients who had low cellular magnesium levels had increased bronchial spasm. This finding confirmed not only that magnesium was useful in the treatment of asthma by dilating the bronchial tubes but that lack of magnesium was probably a cause of this condition.5 A team of researchers identified magnesium deficiency as surprisingly common, finding it in 65 percent of an intensive-care population of asthmatics and in 11 percent of an outpatient asthma population. They supported the use of magnesium to help prevent asthma attacks. Magnesium has several antiasthmatic actions. As a calcium antagonist, it relaxes airways and smooth muscles and dilates the lungs. It also reduces airway inflammation, inhibits chemicals that cause spasm, and increases anti-inflammatory substances such as nitric oxide.6 The same study established that a lower dietary magnesium intake was associated with impaired lung function, bronchial hyperreactivity, and an increased risk of wheezing. The study included 2,633 randomly selected adults ages eighteen to seventy. Dietary magnesium intake was calculated by a food frequency questionnaire, and lung function and allergic tendency were evaluated. The investigators concluded that low magnesium intake may be involved in the development of both asthma and chronic obstructive airway disease.

Before waking the patient, all foreign material such as rolls, gauze and throat packs must be removed and accounted for.

There are some infections that definitely require antibiotic treatment, but more often the need for antibiotics is a gray area. A study published in the journal Pediatrics found that pediatricians prescribed antibiotics 62 percent of the time when they perceived that parents expected them to be prescribed, and only 7 percent of the time when they thought parents didn’t, suggesting that the need for antibiotics is almost always optional. It’s not just children who are being overtreated. Two out of every three adults who see a health practitioner for cold or flu symptoms are prescribed antibiotics, which 80 percent of the time don’t meet Centers for Disease Control and Prevention (CDC) guidelines for antibiotic therapy. When I ask my patients about previous antibiotic use, they usually respond that they took “a normal amount,” but after I have them add up every prescription, they’re often shocked to realize just how much “normal” really is.

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In the past few years he had become conscious of the burden of his own body. He recognized the symptoms. He had read about them in textbooks, he had seen them confirmed in real life, in older patients with no history of serious ailments who suddenly began to describe perfect syndromes that seemed to come straight from medical texts and yet turned out to be imaginary. His professor of children’s clinical medicine at La Salpêtrière had recommended pediatrics as the most honest specialization, because children become sick only when in fact they are sick, and they cannot communicate with the physician using conventional words but only with concrete symptoms of real diseases.

It’s the feeling that one is a cog in a machine that doesn’t care. Burnout makes people angry, depressed, and unable to do or enjoy doing the work of patient care. Burnout is loneliness, isolation, and an invitation to addiction, alcoholism, and other forms of self-harm.

liked internal medicine and pediatrics, but the physicians I followed warned me that those practices were becoming far less personal—to stay afloat, they had to cram in thirty patients each day. If they were starting out now, a few even said, they might consider another field.

to her parents in relief, I asked if it was another one. “No,” her mother said, “it was the same one that was lost.” Dr. X had come that afternoon and brought it to them. I told them how glad I was that it had been found. “Yes,” her father said. “We are too.” Then he smiled. “She is safe now, no matter what happens,” he told me. The following morning, the surgery resident told me how the medal had been found. On the previous day, Dr. X had made his patient care rounds much as usual, followed by a dozen of the young surgeons he was training. But instead of ending the rounds in the ICU, he had taken them all to the laundry department in the subbasement of the hospital. There, he explained what had happened, and then he and all his residents and fellows had gone through the pediatric laundry from the day before

A retrospective review of more than 5000 patients found that the “presence of a visible hole, diffuse fibrinopurulent exudate, intra-abdominal abscess, and extraluminal fecalith” were all associated with worse outcomes and should serve as criteria for defining complicated appendicitis. 28

stepped down as their program director, the residents still humor me on Saturday mornings after rounds as we drink coffee and I draw arrows and boxes on the whiteboard linking their pasts to their futures, each time returning to the topic of identifying mentors on their own career journey, to seek out those with admirable qualities or desirable skill sets to incorporate into a new self.

SOME MONTHS LATER, in July 2003, Rose Firestein was browsing the official Web site of the Food and Drug Administration when she suddenly reared back in surprise. She blinked and looked again. Buried in the third paragraph of an FDA press release, dated June 19, 2003, was this sentence: “Three well-controlled trials in pediatric patients with MDD [major depressive disorder] failed to show that [Paxil] was more effective than placebo.” The reference to these negative findings about Paxil mystified Firestein. Why would doctors so readily prescribe Paxil (making it by 2003 the second most widely prescribed antidepressant for those under eighteen years old) if the results of drug tests were uniformly negative?

Dr. David Wilson is a Utah-licensed psychiatrist whose focus on pediatric patients extends to coordinating care with diverse healthcare providers. Currently, at Salt Lake Behavioral Health, he continues his commitment to mental health.

I came to understand the importance of time itself as the fourth dimension of anatomy[...]

There is always an applicable Shakespeare quote, even in the operating room. Perhaps especially in the operating room.

I remember feeling like I had two hands full of thumbs and invincible at the same time.

Early in your training, there is something powerful about body fluid, sacrificial that you are willing to be bathed in it.

I prefer to focus on the wonder, and let this next generation of surgeons take up the arguments, find those answers, push the field forward.

What was clear to me was that these young doctors needed to tell their stories to one another. To process the significance of what they were doing every day, to reckon with the feelings that they were coming home with every night. There were no easy answers. But the residents spoke of their patients with

A great story about a big company’s ability to do this comes from one of the world’s biggest businesses, General Electric. I learned about Doug Dietz a few years ago when I saw him speak to a group of executives. Doug leads the design and development of award-winning medical imaging systems at GE Healthcare. He was at a hospital one day when he witnessed a little girl crying and shaking from fear as she was preparing to have an MRI — in a big, noisy, hot machine that Dietz had designed. Deeply shaken, he started asking the nurses if her reaction was common. He learned that 80 percent of pediatric patients had to be sedated during MRIs because they were too scared to lie still. He immediately decided he needed to change how the machines were designed. He flew to California for a weeklong design course at Stanford’s d.school. There he learned about a human-centric approach to design, collaborated with other designers, talked to healthcare professionals, and finally observed and talked to children in hospitals. The results were stunning. His humandriven redesigns wrapped MRI machines in fanciful themes like pirate ships and space adventures and included technicians who role-play. When Dietz’s redesigns hit children’s hospitals, patient satisfaction scores soared and the number of kids who needed sedation plummeted. Doug was teary-eyed as he told the story, and so were many of the senior executives in the audience. Products should be designed for people. Businesses should be run in a responsive, human-centric way. It is time to return to those basics. Let TRM be your roadmap and turn back to putting people first. It worked for our grandparents. It can work for you.

have treated a few moms who probably caught C. diff from their newborns. I have also treated a neonatologist (a pediatric specialist in newborn diseases) who probably picked up C. diff at work from one of her sick newborns.

Recently, single and multi-institution retrospective studies have shown a higher rate of postoperative stricture in patients who had transanastomotic tubes.

At the root of the problem? That sticky wheat protein, gluten. Although the jury is still out on the connections between gluten sensitivity and behavioral or psychological issues, we do know a few facts: People with celiac disease may be at increased risk for developmental delay, learning difficulties, tic disorders, and ADHD.6 Depression and anxiety are often severe in patients with gluten sensitivity.7, 8 This is primarily due to the cytokines that block production of critical brain neurotransmitters like serotonin, which is essential in regulating mood. With the elimination of gluten and often dairy, many patients have been freed from not just their mood disorders but other conditions caused by an overactive immune system, like allergies and arthritis. As many as 45 percent of people with autism spectrum disorders (ASD) have gastrointestinal problems.9 Although not all gastrointestinal symptoms in ASD result from celiac disease, data shows an increased prevalence of celiac in pediatric cases of autism, compared to the general pediatric population. The good news is that we can reverse many of the symptoms of neurological, psychological, and behavioral disorders just by going gluten-free and adding supplements like DHA and probiotics to our diet.

In Tulsa, Oklahoma, two pediatric nurses—Donna Wong and her colleague, Connie Baker—sought a way of assessing pain in children who had trouble describing what they felt. Wong was incorrectly diagnosed with leukemia as a child, and subjected to painful operations without the aid of analgesics. She became a nurse. In the 1980s, with the smiley face fad in recent memory, the women devised a series of six faces a child could point to. The chart begins with a smiling face and ends with a tearful, grimacing face. The Wong-Baker FACES scale is now a standard in gauging pain in children. There are other versions for adults. Patients are asked to quantify their pain according to a scale—numbered from 0 to 10, 10 being worst. These scales were highly subjective, but they were about the only pain-measurement tools medicine had to offer.

But that last clinic appointment, that last time I saw Katie, I could look at her and see heaven. I don’t ask you to understand or even believe me, but I could see it. Just as clear as I can see Death. I saw heaven through Katie. It’s not that I think I see it; I know I see it, just as I see heaven in the eyes of my bratty kid or any of my other hundreds of patients. I know there’s value. I know there’s love. I know that there’s a loving God welcoming Katie into heaven. I could see it. I can’t explain it. I can’t begin to ease the stabbing hurt in Katie’s family. I won’t even try. But there is heaven.