Pediatrics is a kind of medical practice in which the doctor watches children grow from infancy into young adults. Many people have the idea that a doctor’s job is merely to see sick patients , “diagnose” their illness, prescribe treatment, and send them on their way. This conception is reinforced a great deal by what we see in medical shows on television. But, in pediatrics, we spend a lot of time actively getting to know our patients as individuals. Admittedly , it works out to little snippets of 15 to 30 minutes duration at check-up visits. Other things play into it, including immunizations and screening tests. However, over the course of years I have come to know a lot about our patients as unique individuals.
We assess each child’s development. At each visit we want to make sure that each child is meeting certain milestones. We start early. Does the one-month-old baby look at his or her mommy or daddy when lying on the exam table?. Does the two month old smile? Can the 9 month old sit alone, stand and “cruise” holding on to furniture, the 12 month old say “Mama, Dada.” Does the two and half year old speak in short sentences? These so-called milestones seem cut and dried, but in the process we see the child’s personality unfold, flower and bloom. Not only do we see them learn to walk, talk, eat, dress, travel, go to school, play sports and take SAT’s, but we get to see them become their own person.
So, what is my goal in caring for these young people? What truly is the job, the mandate, the mission of this practice? It’s not simply to promote the physical health of children. It’s to make sure they become self-sufficient and able to take care of themselves as adults. They need to embrace the significance of work, economic support, and of family. They need to learn about the importance of responsibility to themselves, to their families, their neighbors, and their community. They need to believe in the value of education, and to aim for college, and satisfying careers.
How can I promote this in the office where I have to keep my eye on the clock, make sure I get patients in and out efficiently, cover all the bases of preventive care and do it in 15, 20, or 30 minutes? Weigh, measure, check blood pressure, check ears, mouth, lungs, heart,abdomen, reflexes, scoliosis screen vaccines, do health forms and write up working papers? To me, the key is to address young people with respect and interest. Address them with the expectation that they will be conscientious students, plan for college and employment, and that they will be strong, confident, and self-reliant adults.
In my practice, I see children from nearly every socioeconomic level represented in Manhattan, in New York City. I work on the West Side, near the Columbus Circle Subway station, which to me is the nexus of the most incredible strip of land, ranging from Battery Park, the World Financial Center, the housing projects of Chelsea, the tenements (and condominiums) of Hell’s Kitchen, Lincoln Center, Columbia University, Harlem and Washington Heights. We see children of immigrants whose parents are sometimes nearly illiterate, or who, despite years in Manhattan, have not learned to speak English, but also children of celebrities, lawyers, entrepreneurs, and other doctors. And children from every country in the world. I try to let them know, verbally and non-verbally, that I expect the same self reliance and motivation regardless of their background.
The greatest gratification I have felt, is to see the high school students and college freshmen, whom I treated as babies or kindergarteners, planning their futures, pursuing schooling and careers, and thinking about supporting the families who brought them up in this neighborhood where so many of the riches of life are on display–culture, beauty, and enterprise.