Advice for New Parents: how an ER doc became a primary care doc, and began changing the world.
The Attentive Child
Recently I had a single mother on social assistance come into the E.R. with an 8 month old boy in tow. The child had a minor complaint, something that really didn’t need to be seen by a doctor, and certainly didn’t need to be seen in the emergency room. You know the type.
After checking them in, the clerk came into the office and remarked how alert and intelligent the child was, that he had observed her quietly the whole time she was working. She then laughed that when she mugged at him he mimicked her, making faces the mother had never seen before.
The Read-To Child
I can identify a child who has been read to at 6 months of age, even younger. They are more confident, less fearful, more observant, more in control of themselves, and more curious. I have seen children under a year old, who cried from fear as I examined them, but who nevertheless held still and even cooperated with my exam, while they continued to cry.
Before I examine a child, I usually try to interact with him/her a bit and chat with the parents, and give the child time to get used to me. The little boy above was clearly one of the children who have been read to.
So I asked the mother my standard question, “Are you reading to him?”, even though I already knew the answer.
Or at least I thought I did. Because in this case, the mother surprised me by saying, “Oh, I read to all five of my children.”
Surprised I said, “That’s great. How did you decide to do that?”
She gave me a puzzled look and replied, “You told me to.”
She then explained to me that after I had talked to her a couple of years before, she took my advice and began reading to her kids. All of them had subsequently developed an interest in books, and she told me that her oldest, the 9 year old, was reading all the time.
The emergency room hosts a lot of loss, pain, and grief, and with time you learn to be a bit stoic. So I don’t often get emotional. But I choked up a little bit when she told me that.
I have retired now, but I didn’t much enjoy medicine. I’m a scholar and a writer at heart, but that won’t pay the bills. U.S. medicine just pays too much money, even in quiet, out of the way places. So I worked those quiet jobs, and wrote and read in between patients.
One of the things that aggravated me for years is that overwhelmingly, emergency room patients aren’t emergencies. Most of the patients I saw didn’t need a doctor, their problems would go away without medical attention. For a long time, I resented the apparent abuse of the system. But I gradually came to realize that without the minor and even frivolous visits, there wouldn’t be enough patients to justify an emergency room. This is true even for many large ER’s: there just aren’t enough true emergencies to keep the doors open.
With that, primary care docs book their days full, so there’s not much room to fit in another patient today, or any time soon. And understandably, doctors aren’t willing to work until all hours of the night to see everyone, as we did in the old days; like everyone else, we want to be home with our families. So all of the overflow comes to to the ER.
Finally, the ER is the only place many of the poor can get healthcare, particularly the working poor, who often do not have insurance.
The Emergency Room as Primary Care
As I saw these patients, some of them repeatedly, over my three decades in practice, I began to saw that I was the primary care physician for a lot of them. Since I worked quieter ERs, I realized that I often have a few minutes for counseling about their disease, or even about their lifestyle choices.
Particularly lifestyle choice that affect health. Which is a pretty scattershot blunderbuss: everything in our lives affects our health.
As I have suggested elsewhere, if our brains function reasonably well, we can deal with a lot of disease and adversity. And as my posts here show, I am a big proponent of reading. I strongly believe that if we engage kids with reading as early as possible, it has an enormous, positive impact later on. So I started urging parents, particularly new parents, to read to their children.
More than one parent has come back to me after a year or two, and told me they after they started reading to their kids, they were amazed at the change in their children. They were shocked and delighted at how sharp they were, and at how well they were doing in school. Some of these parents could barely read themselves, but their kids were tearing it up in the classroom.
So much of medicine is obvious. Or like most things, it’s obvious if you’ve studied it. But if you haven’t studied, many things aren’t obvious at all. Likewise, so much of education and raising children is obvious; if, of course, you had supportive parents, and you’ve read a lot and thought a lot, and if you’ve been around a lot of good parents interacting with their children.
The same is true for reading to your children, it’s obvious. But for many parents, it’s not obvious what reading to their children can do. That’s why I think I got choked up. It didn’t take me two minutes to talk to that mother about reading. But for the few seconds I spent with her, her life, and her 5 children’s lives, were dramatically changed, for the better.
We think of medicine as saving people’s lives. In this case, maybe I saved several people’s lives. But unlike a more conventional view of medicine, I did not simply restore them to what they were before. Maybe I helped to make them much better, maybe I gave them a life that was larger, and fuller, and happier.
Advice for New Parents
Anyway, after I started encouraging parents to read to their kids, I began adding other topics. After a few years, I developed a whole little talk, my advice for new parents.
Follows is the full version, which breaks down to three basic points. I almost never give new parents the full talk, I usually just give some abbreviated form, tailored for what I thought would be useful to them. I once had a grandmother complain to the administration about this, even though I had been speaking to her daughter, who was the mother of the child. She certainly listened to me attentively.
But either way, it’s worth an occasional complaint. Where else did I have the opportunity to help so many people, with so little time and effort?
1) Screen Time vs Reading Time
The first topic I often touch on in my advice for new parents involves ‘screen time.’ Research over the past few years has prompted the American College of Family Physicians and the American College of Pediatricians to recommend that we limit screen time in our children — TV, computer, cell phone, electronic games — to no more than 2 hours a day.
But the less the better. Imagination is critical in the modern world. It is important that we learn to ‘see’ things in our heads that we’ve heard or read. A child can’t develop her imagination if she’s constantly watching a machine that does all of her imagining for her.
So in place of of screen time, my advice for new parents is to read to your children, and start as soon as you can sit them on your lap. Read to them every day, as often as you can.
Then, when they get to 3 or 4 years old, begin playing card and board games with them. This lays the foundation for math skills and analytical reasoning later on.
I tell the parents that if you do these two things, your children will amaze you when they go to school, and throughout their lives.
2) Losing a Child
Every parent’s greatest fear is losing a child. But in my advice for new parents, I explain that they will lose their child every night: the child who wakes up in the morning is not the child we put to bed the night before. And we will never – ever – see that other child again.
And then the day will come that will be the last time that our child runs to see us at the door, the last time that we hold her/him in our arms, or the last time that we read to him/her.
And we won’t even know it’s the last time. So we need to treat them all as if they were the last time.
And as if it were the first time.
3) Patience & Faith
I knew a man who got a whipping when he didn’t play well in pee-wee baseball. No good parent would do that today. It would only destroy the child’s interest in baseball, and his self-confidence in playing it.
So why do we put so much more love and patience into teaching our children how to handle a pop-up fly, than we do on learning to handle frustration, disappointment, and self-control? I’m 62 years old, I still struggle with those things. But parents who will patiently teach their children sports or other activities will nevertheless discipline them sternly when they express their fears and frustrations.
Robert Fulghum said it very well, “Don’t worry that your children never listen to you. Worry that they’re always watching you.” We cannot teach true self-control to our children by losing our own self-control.
Our children love us, they need us, and they will work hard for our approval. When they are misbehaving, we often find out later they were tired, or hungry, or worried. And ‘worried’ is the hard part, because often they won’t tell us when they’re worried, or what they’re worried about. The truth is, they’re not always aware of what they’re worried or afraid of themselves.
But to discipline a child is who suffering is not what any of us want to do.
Children figure out most of what they need to do, and how they need to behave, if we just give them some time, and have a little faith. We need to give them lots of praise and patience, and discipline them as little as wew think we can get away with.
So that’s my advice for new parents. Maybe some of you can use it or share it, or change it and make it better. I hope so.
Photograph courtesy of Eugene Kim.