Whom do you trust on the Web?
Those who pause at this web site should
bring a skeptical attitude along with their good intuition.
When you reflect on what is written here, trust your instincts
and ask, “Does this make sense?”
Encouraging the spirit of cautious but interested
inquiry, it seems fair to inform you about my background and
the interests that led me to create this web site.
My journey to psychosocial pediatrics
After completing a pediatric residency and
military service, I was awarded a one-year NIMH fellowship
in child psychiatry, which, at the time, was available to
interested pediatricians. Some years later, I received
an MPH at the Harvard School of Public Health, where I focused
on issues of community psychiatry and nurturing change. I
later received a certificate for a one-year training program
in "alcohol studies" at Boston University School
of Social Work. That experience helped me understand
how growing up in troubled families might affect the competence
of the future parent, and how a pediatrician might be able
to modify the impact of such a history on the children of
such parents.
I incorporated the insights derived from
these training experiences, not to do child psychiatry but
to make use of them in a general pediatric practice. The
question I was left with was, "Would I (and my colleagues)
be able to recognize emotional problems in children and families
earlier than customary and, perhaps, accomplish more in the
area of prevention?"
I participated in the Bright Futures program,
a study conducted by the Children's Bureau and the Health
Care Finance Administration (HICFA), to examine how the role
of pediatricians could include psychosocial issues. In
that study, I suggested that one could do more in the area
of psychosocial pediatrics while still involved in a general
pediatric practice.
Over the years, I have urged managed care
organizations to consider psychosocial issues as an important
preventive component of their health plans. I won their
support for reimbursing pediatricians when they encourage
parents to return for an extra visit to better understand
psychosocial issues when they affect their children.
In my practice, I encourage the parent to
be the family "story teller," also focusing on the
role of family secrets which often pass from one generation
to another and can influence parenting styles. By encouraging
parents to talk about these issues when they are ready, a
pediatrician may be able to favorably affect the emotional
development of children and may possibly reduce their future
vulnerability to addictive behavior.
I have written pamphlets for parents, with
the goal of increasing their decision-making capacity in regard
to health issues for their children. More recently, I coauthored
with Melinda Strauss (the web editor for this site) a guidebook,
Routine Screening for Domestic Violence in Pediatric
Practice. We hope the guidebook will reassure
pediatricians that they can detect this widespread public
health problem and deal with it more effectively in their
everyday practice.
The recurring themes of my professional
life have been to help, to teach, and to learn. In addition
to recognizing that parents and children are my principal
teachers, I have one other valuable resource, my own family. I
am married, with two married children and four grandchildren.
They, in addition to my wife, a clinical social worker who
leads bereavement groups in our community hospital, stimulate
and inspire me, as a spouse and parent, to become more competent
each day.
I am engaged in full-time, solo pediatric
practice. Over time, I have learned to modify the traditional
doctor-patient relationship whereby the process of helping
parents and children has helped me become a better psychosocial
pediatrician. I hope to share these accumulated insights
with colleagues so that they, too, may feel equally gratified.
Listening for the story: the patient as
teacher
As a student at Boston University School
of Medicine, I took a summer externship at Bart's Hospital
in London, England.
I was assigned to the hospital's medical
ward. Dr. Eric Scowen, a distinguished but somewhat intimidating
physician, was in charge. By the end of my stay, he had
evolved into a memorable figure, like someone out of a Dickens
novel.
After I had been there for a short time,
he said, "King, do you see that man at the end of the
third row? His name is William R. He has a crippling
condition of the spine. It is so curved and afflicted
with arthritis he is virtually unable to walk. I want
you to learn everything you can about this man and his condition
and at the end of the summer, you are to tell us his story
and how he learned to cope with his illness."
At that time, I intended to become a pediatrician.
What was I doing in this hospital, learning about a middle-aged
man with an adult disorder? What would be the usefulness
of this experience for me? But this was my assignment. Besides
learning about a severe form of arthritis, I found that William
taught me something equally important. As I sat by his
bedside, he talked about his life, starting from his teenage
years to how he ended up at this hospital. I had begun
to learn how to listen to patients' stories.
By the end of my stay, it seemed as if there
was no other patient on that floor, just "Bill."
In Bill's presence, I presented his story and that of his
illness to my professor and his colleagues. At that time,
there was little in the form of treatment for his condition.
But, as Bill listened to my presentation, did he know he had
become a great teacher to the student who was attempting to
recall the intimate details of his very singular life?
The model of Bill as "teacher"
has remained with me since that time, many years ago.
The reader as teacher
This web site represents my most recent
effort in writing for parents who might be interested in some
helpful thoughts about the mental health issues of children.
It is also meant to reach out to colleagues in order to enhance
their own comfort and insight about such matters.
My interest in the emotional health of children
and families should not persuade the reader that the opinions
so expressed represent the only way of looking at things. Readers,
be they parents or physicians, will decide if what is written
here makes sense to them based on their own critical thinking
as well as their life experience.
This venture has at least two unique features. Because
it is on the web, it is an opportunity to write in a way that
invites revision and rethinking as new material is forthcoming.
More importantly, it invites readers to consider these ideas
and express, interactively, their responses based on application
of these ideas as well as to share their own experiences.
It would satisfy
me greatly if the authorship of this web site includes not
just myself but also its readers, who challenge me at the
same time they allow me to encourage them to rethink what
we do, as parents and doctors. Please do not hesitate
to open a dialogue with me by sending a message of any length,
in Comments. I will make every effort to respond.
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