How an ER doc became a primary care doc, and developed a talk for new parents.
The Attentive Child
Recently I had a mother come in, 8 month old boy in tow, on social assistance. Child had a minor complaint, something that really didn’t need to see the doctor. 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 observed her quietly the whole time she was working. She then laughed that when she mugged at him he mimicked her back, 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 themselves still, and even cooperated with my exam, while they continue to cry. This was clearly one of the children who had been read to.
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. As I often do, I asked the mother my standard question, “Are you reading to him?”
She surprised me by saying, “I read to all five of my children.”
I said, “That’s great. How did you decide to do that?”
She gave me a puzzled look, and then said, “You told me to.” She then related to me how all of her children had developed an interest in books, and that her oldest, the 9 year old, was reading all the time. I don’t often get emotional in the ER, but I choked up a little bit when she told me that.
I don’t much enjoy medicine. I’m a scholar and a writer at heart, but that won’t pay the bills, not yet. And medicine just pays too much money, even in quiet, out of the way places. So I work those quiet jobs, and write 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 see don’t need a doctor, their problems will 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 those people, there wouldn’t be enough patients to justify an emergency room. This is true even of the largest ER’s. There just aren’t enough true emergencies to keep most ERs open.
With that, primary care docs book their days full, there’s not much room to fit in another patient that day, 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 out families. So their overflow comes to us.
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 over the last three decades, some of them repeatedly, I began to recognize that I am the primary care physician for a lot of them. Since I work quieter ERs, I realized that I often have a few minutes for counseling about their disease, or even about their lifestyle choices, particularly those 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 those of you who visit here regularly know, 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, told me they had started reading to their kids, and were amazed at the change in their children, how sharp they were, and how well they were doing in school. Some of these people could barely read themselves, but their kids were tearing it up.
So much of medicine is obvious. Or rather, it’s obvious if you’ve studied it; if you haven’t, it’s not 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 just watched people go through their lives.
That’s why I think I got choked up. It didn’t take me 60 seconds to talk to that mother about reading; but for the few seconds I gave 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.
Anyway, after I started giving parents my suggestions about reading, with time I began developing a whole little talk for new parents. Follows is the full version, with three basic points. I almost never give new parents the full talk, I usually just give some abbreviated form. I once had a grandmother complain to the administration about this, even though I was speaking to her daughter, the mother; and the daughter certainly listened attentively to what I said. But it’s worth an occasional complaint. Where else do we have the opportunity to create so much progress, with so little time and effort?
1) Screen Time vs Reading 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, the abilitiy to ‘see’ something you’ve heard or read. A child won’t develop her imagination if she’s constantly watching a machine that does all of her imagining for her.
Instead of screen time, 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.
When they get to 3 or 4 years old, begin playing card and board games with them. This helps develop math skills and analytical reasoning. 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 good parent’s greatest fear is that we will lose a child. But as a new parent, you should know you will lose your child every night; the child who wakes up in the morning is not the child you put to bed the night before. And you will never – ever – see that other child again.
And the day will come that it will be the last time that your child runs to see you at the door, the last time that you hold her/him in your arms, or the last time that you read to him/her. And you won’t even know it’s the last time.
So treat them all as if they were the last time.
And as if it were the first time. Continued below…
3) Patience & Faith
I knew a man who would get whipped when he didn’t play well in pee-wee baseball. No good parent would do that, 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 importance on learning to handle a pop-up fly, than we do on learning to handle frustration, disappointment, and self-control? I’m 60 years old, I still struggle with those things.
Robert Fulghum said, “Don’t worry that your children never listen to you. Worry that they’re always watching you.” We can never teach true self-control to our children, by losing our own self-control.
Your children love you, they need you, and they will work hard for your approval. When they are misbehaving, you’ll often find out later they were tired, or hungry, or worried; and ‘worried’ is the hard part, because often they won’t tell you when they’re worried, or what they’re worried about. 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. Give them lots of praise and patience, and discipline them as little as you think you can get away with.
So that’s my talk 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.