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A healthy partnership

November 08, 2004|by ANDREA ROWLAND

andrear@herald-mail.com

Pediatricians share a special relationship with parents, partnering with caregivers to give children a healthy start in life.

"It really is a team atmosphere, with the team's goal being that the baby will grow up to be a happy, healthy adult," said Dr. Ruth Dwyer, pediatrician at Antietam Pediatric & Adolescent Care in Hagerstown. "I feel very much a part of the team."

Like family practitioners, pediatricians often perform many roles besides primary medical care, said Dr. Albert Strauss, pediatrician at The Children's Doctor, with offices in Hagerstown and Boonsboro

"We're counselors. We're psychologists. We're social workers. We're a very important clearinghouse," he said. "It's a very holistic thing - as is most primary care."

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"Sometimes I view my role as a clearinghouse for other parents' good ideas," Dwyer added.

In addition to monitoring kids' growth and development, giving immunizations, and treating illnesses and injuries, the American Academy of Pediatrics encourages pediatricians to take such proactive measures as partnering with parents to find the best available child-care providers. The academy also advocates that pediatricians help to ease the transition for children of divorced parents, according to information on the academy's Web site at www.aap.org.

That's because social and environmental factors - not just germs - affect a child's health and general well-being, pediatricians said.

"We focus primarily on the child and the child's nuclear family," Strauss said. "We have to look into the intricacies of the paternal and maternal relationships with the child."

Social and development issues are a big part of pediatrics, Dwyer agreed.

"A lot of pediatrics is development," she said. "And a lot of pediatrics is preventative."

Bedside manners


The pediatrician's youngest patients lack the medical history that can give doctors important health insights; and slightly older children often lack the ability to articulate medical concerns, Strauss said. Pediatricians must rely upon parents and other caregivers for pertinent information, he said.

"We need parental input 100 percent," Strauss said.

Parents and pediatricians can't form a successful team without honest and open communication, Dwyer said.

"We're only able to be as helpful as parents will let us," she said.

Bedside manner is key in the pediatrician's business.

"It's one of the single most significant aspects of what we do," Strauss said. "If a doc can't relate to his patient, who is frequently a scared little child, everything's going to fall apart."

Pediatricians must hone two sets of communication skills - one for young patients and one for their caregivers, Dwyer said. She said the most important aspect of a pediatrician's bedside manner with parents is the ability to listen effectively.

Proactive parents


Listening, learning and asking intelligent questions are among the most important actions parents can take to ensure the best medical care for their children, the pediatricians said.

"Well-informed parents, I think, are some of our most important allies," Strauss said. "Parents are becoming more sophisticated all the time."

Today's parents are less likely than in years past to demand antibiotics for each and every childhood illness, he said. They seem to know about antibiotic resistance and the emergence of so-called "superbugs" due, at least in part, to over-prescription of such antibiotics as penicillin. And many parents take the time to learn as much as they can about their children's diagnoses - often through Internet searches, Strauss said.

On the flip side, addressing caregiver lifestyle choices that affect the health of young patients is one of the most challenging aspects of the pediatrician's job, Strauss said. Second-hand smoke is a huge issue, he said.

"When you have a wheezing child and parents who smell like smoke, that's frequently a contentious issue," Strauss said. "Parents sometimes get upset when they hear the damage they're doing to child, but I have to tell them. I feel very, very strongly about that. Second-hand smoke is a killer."

And some parents don't want to acknowledge that their children could be suffering from such mental health problems as depression or attention-deficit disorder, he said.

"Sometimes there's a real problem with parental denial," Strauss said.

Dwyer said doctor-patient confidentiality can be an issue with the parents of adolescent patients.

"The parents often view themselves as the clients," she said.

But Strauss and Dwyer said the rewards of their work far outweigh any obstacles to it.

"I get to play and relate to children, whom I love," Strauss said. "I find my work immensely gratifying."

"This is a job that's a real blessing to do," Dwyer added. "Ninety-nine percent of the time I love it."

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