Even after a lifetime of regular checkups, for adults, visiting a doctor’s office can be fraught with anxiety, self-consciousness and irrational fear.
The feeling of a cold stethoscope on your chest, a rubber band cutting off circulation to your arm, a light shining in your eye and a needle penetrating your muscle – these are not pleasant sensations.
For children, such endeavors can require considerably more bravery, said Dr. Kim Caruso of Pediatric Partners of the Southwest.
And for doctors, treating children can require considerably more skill.
Such is the anxiety produced by pediatric patients, at Medscape, a medical news website, Dr. Dipesh Navsaria writes: “One of the most anxiety-provoking experiences for medical students is pediatrics. ... In fact, I’ve seen intelligent, proficient students stopped dead in their tracks, intimidated by a willful 15-month-old, completely unsure of what to do next.”
In the online article “More Magic Tricks for Pediatric Patients” for Harvard Medical School’s journal Personal Medicine, Dr. Eric Zwemer provides nervous, overwhelmed internists with a meticulous, play-by-play breakdown of various “magic-based” strategies for treating children, including one trick called, “Sleight of Hand Sanitizer,” whereby a physician tapes a coin to her hand and, eight steps later, induces a child to sanitize his hands.
These tactics are nothing to the Pediatric Partners of the Southwest’s arsenal.
“A lot of adult providers hate pediatric patients,” said Caruso. “But we kind of self-selected ourselves to work with patients who aren’t perfectly verbal – most of us fell in love coming to work and dealing with kids, probably because we’re a smidge childish ourselves.”
The result is a practice that takes pride in its staying at the cutting edge of pediatric medicine while also rejoicing in all things childish.
Appealing to childrens’ imagination
Mary Gilman, a full-time integrated behavioral health specialist at the practice, said one of the biggest recurring challenges she faces is that, for children, illness can be an alibi. Children say they can’t go to school because their tummy aches, when, actually, they’re physically dreading an older child who bullies them.
Gilman is especially adept at explaining short-term cost versus long-term benefit to children. Persuading them to forebear a needle for the sake of acquiring lifelong immunity to ghastly diseases can require patience.
Dr. Cecile Fraley, Caruso and Dr. Kelly Miller described techniques that appeal to childrens’ imagination and amenability to theatrics.
For instance, when warts need freezing, they’ll let kids dump the liquid nitrogen on the floor.
When they need to check childrens’ ears with a light, they’ll invite them to blow out the light, as if extinguishing it.
“Then, I let them check my ears, too,” said Caruso.
Fraley agreed that patients’ reciprocating your investigations is important, though, in her case, everyone’s ears – doctors’ and patients’ – are checked for dinosaur poop.
“I like to talk about poop,” she said.
These elaborate exercises in medical subterfuge are highly effective and engender a loyal following.
“I’m on my second generation,” Fraley said. “But Dr. Bob McGrath has been here 37 years. He’s now treating the grandchildren of his first patients. It gives really good insight into the family system to know them through the generations.”
Fraley said, “Patients come up to me in the grocery store telling me they got an A on their spelling test or that they’re not having nightmares anymore because of the nightmare spray we used.
“Once a mother invited me to Disneyland, because her son said he didn’t think he could go unless Dr. Fraley comes,” she said.
And practitioners’ confidence in dealing with children is useful in all kinds of medical circumstances.
Dr. Heidi McMillan said the standing complaints are strep throat, ear infections, coughs, upper respiratory issues, constipation, influenza and gastro-intestinal issues.
But children also manage to come down with exceedingly exotic ailments.
Dr. Brenda Huffman said, “We’ve had the bubonic plague while I’ve been here.” They have also seen children who have fallen unconscious because of unusual viruses that affect kids more than adults.
Fraley recalled extracting the stalk of steamed broccoli out of one patient’s nostril.
“It was stringy, and pieces kept breaking off in his nose,” she said. “I told the parents, next time, cook it more al dente.”
Which brings the staff to its biggest magic trick:
McMillan said, “One of the biggest challenges whenever you’re caring for a child is that you are actually dealing with two clients, the patient and the child’s parent.”
She said to get children to accept treatment, “you need to be sensitive to both the needs of the patient and cognizant of their parents’ needs.”