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Pediatrics

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Mind the Foliage

I take care of patients of all ages, but a substantial amount of my time is devoted to routine pediatrics.  I try to make a good impression on the kids, knowing that my care will be a lot easier if they aren’t terrified by my presence.  Those who don’t do pediatrics often say the reason they don’t want to care for children is to avoid “all those screaming kids.”  I want to avoid “all those screaming kids too,” but I do it through good PR.  I joke with them, tickle them, find peanut butter in their ears, and other tactics to make them comfortable.

This approach has an added benefit regarding the other reason doctors don’t want to see kids: the parents.  If the kids like me, the parents are much more likely to listen to me.  One of my favorite things to hear is for a parent to say how their child wants to come and “see Dr. Yamberts” when they are sick.  I periodically have kids running to me at the hardware or grocery stores, throwing their arms around my legs in a tight hug.  It’s my tranquilizer/blood pressure drug of choice.  Life is good when my patients love me.

It is strange to think about me being the image these children have of my profession.  When the word “doctor” comes up, they picture me.  They think of doctors examining under their arms for fictional problems as an excuse to tickle.  They think of doctors having Scooby Doo stickers on their stethoscope.  They think of the doctors office as a place where they can laugh and where they are cared for.

OK, it also helps that I am juvenile in my humor and that I actually enjoy playing with them.  It’s not just PR; it’s self-indulgence.  It’s definitely a win-win.

But I was met with a different reaction from one of my regular patients recently.  I was joking around with this intelligent boy who was at my office with his mother for her visit.  He was telling me about school and about how he likes math problems, but doesn’t like taking the tests.  I started teasing him about the girls in the class - something I take great pleasure doing to boys of a certain age.  They react as if girls are covered with radioactive Ebola virus.  It’s hilarious.

Perhaps it was out of spite, or perhaps he was just being a typical guileless kid, but he interrupted my teasing: “You know what, Dr. Lamberts?” he said, sounding serious in his tone.

“What?” I answered, waiting for his words of wisdom.

“You really need to take care of something…a situation,” he continued.

“And what is that?” I asked.

“You need to cut your nose hair.”

His mom let out a yelp and I started laughing, suddenly self-conscious about my hirsute nares.  He sat there, still serious, as if he had said something profound.

“I’ll take care of that as soon as possible,” I responded when I caught my breath.  “Thank you for letting me know about that.”

Upon leaving the room I went immediately to my office, got a pair of scissors, and trimmed the locks in my schnoz.  It wasn’t all that bad, was it?

It left me wondering how many kids had noticed this and not told me.  How many kids were disturbed by my nasal foliage?  How many kids out there didn’t see me as the funny doctor, or the one who tickles, but the one with the creepy nose hair?

I’ve been obsessing about it ever since.

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Innocence and Innocents

Which is worse:

  • Falsely accusing someone of child molestation?
  • Allowing a child to be molested?

When the child molestation scandals at Penn State and Syracuse University erupted, I have to confess that I had mixed emotions about the universal outrage.  It may seem like the decision to accuse a suspected child abuser would be easy; but in truth it is one of the hardest decisions a person can face.  I know this because I could face this decision every day I go to work as a pediatrician.  It's terrifying.  Just how much suspicion is enough suspicion?

On one hand, of all the crimes committed against humanity, I find those done against children to be the most egregious.  Child abuse, child molestation, and child exploitation are the basest examples of the strong harming the weak, the powerful subjugating the powerless.  These crimes are a betrayal of the ultimate innocent trust of childhood and should be met with the harshest punishment.

But it is the extremity of this crime and the social outrage thrown against it that, ironically, makes it one of the most difficult fingers to point.  Accusing a person of child molestation will lead to two possible outcomes for the accused: they will be exonerated, yet bear the weight of false accusation and suspicion for the rest of their lives, or they will be convicted and forever wear the label of "child sex offender."  The gravity of the accusation makes it feel like a decision of whether or not to kick a hornets' nest with bare feet.  To make the accusation, you really need to be sure you are right.

But this hesitation may mean that children continue to be abused and sex offenders continue to commit crimes.  I suspect that every pediatrician, family physician, and emergency physician bears at least a small amount of uneasiness at the idea that some of the children we see are being abused and then don't know which children it is.  Statistics say that child abuse is not rare, yet most child sex offenders get away with their crimes for years. Which of the children I see today are the ones?  Where am I missing a chance to help the innocent?

My emotions on this issue are heightened even more by the fact that the pediatrician I had as a child ended up being convicted of child molestation.  I don't remember any encounter with him that makes me think I was ever a target, but I have to trust that the legal system did its job correctly in his case.  But now that I am a pediatrician, I find myself wondering if I am at risk for accusation.  I routinely do genital exams on infants - it happens numerous times every day (and only 50% of my practice is pediatrics).  So what if a parent mistakes my exam for undescended testes as an act of fondling?  What about the hernia check on boys for sports physicals?  Just the accusation of molestation would have a devastating effect on my practice.  I would be "that doctor accused of molestation," regardless of how much merit there was in the accusation.

So I tread on this territory very lightly.  As a pediatrician, I have the physical and emotional needs of the children I care for as my highest interest.  I don't want any children to be abused on my watch.  Yet I know what a difficult thing it is to know for sure and I also don't want to destroy someone's life with false accusation.  Just how much suspicion is enough suspicion?

I deliberately avoided the lurid details of the Penn State and Syracuse sex abuse scandals, so I won't say what anyone should have done.  Certainly anyone witnessing abuse and reporting it should be heard with the utmost of urgency.  It does seem, in the Penn State situation, that the best interests of children were put far below the success of the lucrative sports program.  Yet I can't help getting a little angry when I hear the self-righteous ranting of the press about how Joe Paterno should've acted.  It's not an easy choice, especially with someone who is a friend, to think the worst about them.  It's not easy to kick that hornet's nest.  Perhaps the house-cleaning at Penn State was necessary, and perhaps Joe Paterno was guilty of turning a blind eye.  I don't know.  But I do know the emotion he felt when he was told about the abuse: he was terrified.  Anyone in their right mind is terrified in that situation.

It's presumption of innocence versus protection of the innocent - two of the most sacred things in our society.  So which is worse?  Come on, self-righteous members of the press, which would you chose?  Just how much suspicion is enough suspicion?

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