Squeaking up

I don’t harbor many regrets. Oh, there was the ocean front lot next to our cottage I should have bought for a third of what it’s worth now. But, like most congenitally happy people, I have a very short memory for unfortunate situations. It’s not that I haven’t done things I should be regretting. It’s just that they have disappeared into the haze of my distant memory.

The one glaring exception to my blissfulness is the regret that I didn’t venture beyond the boundaries of a traditional primary care practice often enough to help some of my neediest patients. Sure, I went out in the middle of the night to meet concerned families in my office. I view those trips as well within the scope of practice for a pediatrician in a small community. I made one or two house calls per decade, but it was usually because they were more convenient for me.

What I regret is that too often I was content with making the diagnosis that superficially appeared to best fit the patient’s presenting symptoms and complaints. Then I would prescribe the standard textbook remedy, although many times I knew that the patient’s social situation or a flaw in the bureaucracy of medical care was really at the root of the problem.

For example, let’s say I have a 9-year-old patient with asthma who is usually fairly well controlled, but when he goes to stay with his father on one weekend every other month he will often end up in the emergency room with an exacerbation. None of these episodes are very serious, but ... they do affect his quality of life. Once or twice a year he may miss school on Mondays following a visit to his father’s home. The boy’s mother has some suspicions about environmental conditions and medication compliance issues, but doesn’t seem very concerned about the situation.

I knew – or at least strongly suspected – that the answer to this child’s less than optimal management was a deeper look into what was going on at his father’s home and his behavior. But this would mean taking the initiative on my part to ask the father, who lived out of state and whom I had never met, to come in and be interviewed. My attempts to investigate might stir up some postmarital ugliness, that at least according to the mother, seems to have subsided to an acceptable level. By retreating into my comfort zone of traditional practice, wasn’t I failing to advocate for my patient?

A recent article in Pediatrics entitled “A Common Thread: Pediatric Advocacy Training” by Dr. Kristin Schwarz and associates (2015;135:7-9) suggests that had my training included a few weeks of advocacy training, I might have been better prepared to address this young asthmatic patient’s situation. As the authors of the article point out, advocacy can occur at a variety of levels, all the way from speaking out at a national or state level or becoming involved in community efforts to improve child health to the very personal example I’ve described. They define advocacy as “endorsing effective solutions.” Although my inaction may have been rather minor, clearly I was not truly providing an effective solution.

I’m not a going-to-meeting kind of guy, and I don’t have the patience to navigate the bureaucratic scaffolding on which governments and insurance companies are built. So it is unlikely that I will ever be much of an advocate on a grand scale. But there was an abundance of situations in which the best thing for my patient would have been to step out of my passive let-the-problems-come-to-me approach and make a few extra phone calls to advocate. Of course, I did make those calls from time to time, but I regret not having done it often enough.

There was always an abundance of excuses. I didn’t get paid for phone calls; I was too busy with the scores of patients with squeaky wheels that needed to be greased. If I had to do it all over again, I would do a lot more squeaking myself to create solutions to the real problems of my most vulnerable patients.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected]. Scan this QR code to read similar articles or go to pediatricnews.com.

I don’t harbor many regrets. Oh, there was the ocean front lot next to our cottage I should have bought for a third of what it’s worth now. But, like most congenitally happy people, I have a very short memory for unfortunate situations. It’s not that I haven’t done things I should be regretting. It’s just that they have disappeared into the haze of my distant memory.

The one glaring exception to my blissfulness is the regret that I didn’t venture beyond the boundaries of a traditional primary care practice often enough to help some of my neediest patients. Sure, I went out in the middle of the night to meet concerned families in my office. I view those trips as well within the scope of practice for a pediatrician in a small community. I made one or two house calls per decade, but it was usually because they were more convenient for me.

What I regret is that too often I was content with making the diagnosis that superficially appeared to best fit the patient’s presenting symptoms and complaints. Then I would prescribe the standard textbook remedy, although many times I knew that the patient’s social situation or a flaw in the bureaucracy of medical care was really at the root of the problem.

For example, let’s say I have a 9-year-old patient with asthma who is usually fairly well controlled, but when he goes to stay with his father on one weekend every other month he will often end up in the emergency room with an exacerbation. None of these episodes are very serious, but ... they do affect his quality of life. Once or twice a year he may miss school on Mondays following a visit to his father’s home. The boy’s mother has some suspicions about environmental conditions and medication compliance issues, but doesn’t seem very concerned about the situation.

I knew – or at least strongly suspected – that the answer to this child’s less than optimal management was a deeper look into what was going on at his father’s home and his behavior. But this would mean taking the initiative on my part to ask the father, who lived out of state and whom I had never met, to come in and be interviewed. My attempts to investigate might stir up some postmarital ugliness, that at least according to the mother, seems to have subsided to an acceptable level. By retreating into my comfort zone of traditional practice, wasn’t I failing to advocate for my patient?

A recent article in Pediatrics entitled “A Common Thread: Pediatric Advocacy Training” by Dr. Kristin Schwarz and associates (2015;135:7-9) suggests that had my training included a few weeks of advocacy training, I might have been better prepared to address this young asthmatic patient’s situation. As the authors of the article point out, advocacy can occur at a variety of levels, all the way from speaking out at a national or state level or becoming involved in community efforts to improve child health to the very personal example I’ve described. They define advocacy as “endorsing effective solutions.” Although my inaction may have been rather minor, clearly I was not truly providing an effective solution.

I’m not a going-to-meeting kind of guy, and I don’t have the patience to navigate the bureaucratic scaffolding on which governments and insurance companies are built. So it is unlikely that I will ever be much of an advocate on a grand scale. But there was an abundance of situations in which the best thing for my patient would have been to step out of my passive let-the-problems-come-to-me approach and make a few extra phone calls to advocate. Of course, I did make those calls from time to time, but I regret not having done it often enough.

There was always an abundance of excuses. I didn’t get paid for phone calls; I was too busy with the scores of patients with squeaky wheels that needed to be greased. If I had to do it all over again, I would do a lot more squeaking myself to create solutions to the real problems of my most vulnerable patients.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected]. Scan this QR code to read similar articles or go to pediatricnews.com.

I don’t harbor many regrets. Oh, there was the ocean front lot next to our cottage I should have bought for a third of what it’s worth now. But, like most congenitally happy people, I have a very short memory for unfortunate situations. It’s not that I haven’t done things I should be regretting. It’s just that they have disappeared into the haze of my distant memory.

The one glaring exception to my blissfulness is the regret that I didn’t venture beyond the boundaries of a traditional primary care practice often enough to help some of my neediest patients. Sure, I went out in the middle of the night to meet concerned families in my office. I view those trips as well within the scope of practice for a pediatrician in a small community. I made one or two house calls per decade, but it was usually because they were more convenient for me.

What I regret is that too often I was content with making the diagnosis that superficially appeared to best fit the patient’s presenting symptoms and complaints. Then I would prescribe the standard textbook remedy, although many times I knew that the patient’s social situation or a flaw in the bureaucracy of medical care was really at the root of the problem.

For example, let’s say I have a 9-year-old patient with asthma who is usually fairly well controlled, but when he goes to stay with his father on one weekend every other month he will often end up in the emergency room with an exacerbation. None of these episodes are very serious, but ... they do affect his quality of life. Once or twice a year he may miss school on Mondays following a visit to his father’s home. The boy’s mother has some suspicions about environmental conditions and medication compliance issues, but doesn’t seem very concerned about the situation.

I knew – or at least strongly suspected – that the answer to this child’s less than optimal management was a deeper look into what was going on at his father’s home and his behavior. But this would mean taking the initiative on my part to ask the father, who lived out of state and whom I had never met, to come in and be interviewed. My attempts to investigate might stir up some postmarital ugliness, that at least according to the mother, seems to have subsided to an acceptable level. By retreating into my comfort zone of traditional practice, wasn’t I failing to advocate for my patient?

A recent article in Pediatrics entitled “A Common Thread: Pediatric Advocacy Training” by Dr. Kristin Schwarz and associates (2015;135:7-9) suggests that had my training included a few weeks of advocacy training, I might have been better prepared to address this young asthmatic patient’s situation. As the authors of the article point out, advocacy can occur at a variety of levels, all the way from speaking out at a national or state level or becoming involved in community efforts to improve child health to the very personal example I’ve described. They define advocacy as “endorsing effective solutions.” Although my inaction may have been rather minor, clearly I was not truly providing an effective solution.

I’m not a going-to-meeting kind of guy, and I don’t have the patience to navigate the bureaucratic scaffolding on which governments and insurance companies are built. So it is unlikely that I will ever be much of an advocate on a grand scale. But there was an abundance of situations in which the best thing for my patient would have been to step out of my passive let-the-problems-come-to-me approach and make a few extra phone calls to advocate. Of course, I did make those calls from time to time, but I regret not having done it often enough.

There was always an abundance of excuses. I didn’t get paid for phone calls; I was too busy with the scores of patients with squeaky wheels that needed to be greased. If I had to do it all over again, I would do a lot more squeaking myself to create solutions to the real problems of my most vulnerable patients.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at [email protected]. Scan this QR code to read similar articles or go to pediatricnews.com.