As I stared at the patient intake form, the many diagnoses screamed out at me: ADHD, Asperger’s, ODD, conduct disorder. Twenty-odd drugs tried and failed, Baker acts and inpatient hospitalizations. From these words, a troubling image of a hardened 17-year-old grew in my mind. This was going to be a tough case.
I was surprised to meet a pleasant young man who supposedly reflected the array of diagnoses I had read before. Instead of an emotionally damaged child full of rage and aggression, I heard a tragic story about the medical field failing a child with Asperger’s. Labeling him with so many diagnoses gave doctors different drug options to test on the patient. Like a guinea pig, he had endured years of failed drug regimens and involuntary commitments because the symptoms of his Asperger’s are an issue that modern medicine cannot treat.
Children on the autism spectrum often have trouble controlling their behavior and impulses. Unfortunately, it is a problem most people try to treat with medication rather than behavioral therapy. There are not extensive writings on autistic spectrum therapy, let alone drug regimens proven to reduce symptoms of aggression in children. Instead, most children, like this patient, are treated extensively (and often unnecessarily) until the correct drug cocktail seems to work.
As medical professionals, we must admit that the autism spectrum is an unknown territory for us. We don’t understand the causes, but that shouldn’t reflect our treatment and attitudes towards autistic patients. Our lack of understanding should not be reflected in a pharmacological guessing game. Instead of placing unnecessary labels, we need to individualize treatment and look for alternatives to pharmacology. We need to educate ourselves on autism management, such as applied behavior analysis, verbal behavior therapy, dietary modification, and equine therapy. There may not be a magic pill for patients with autism, but a caring physician armed with therapeutic knowledge can be a wonderful alternative.
Stephanie Be, DO, MPH
“I know exactly what this patient needs, but I am not the person to provide it for him.” More than once in my short time as a pediatrics resident, I have had to come to terms with the fact that I cannot be and do everything for every patient. I have had to remind myself of this when I’ve had a patient with an unstable home situation, but one that doesn’t warrant intervention by child protective services. I have had to remind myself of this when I’ve had a patient who was cleared by psychiatry but clearly still in need of long-term psychological counseling and therapy. I have had to remind myself of this when I have had a patient who was medically cleared but unable to leave the hospital because of a guardianship issue.
What do we do in these situations? We call in all the troops: we call CPS, we call social work, we call every consultant we can. But what do we do about the in-between kids? The ones who have been “signed off” by everyone involved, but whom we know still need help? As it stands, we discharge them from the hospital, meaning we send them home to the same situations they came from. Because acute care hospitals are only for acute problems, not for healing the entire patient.
As osteopathic physicians, we understand that the basis of disease and health involves not just physiology, but also environment and individual. We feel frustrated when we are only able to treat our patients’ physical ailments.
Excellent primary care is the bridge between acute care and overall wellness. Primary care pediatricians have the opportunity to advocate for our patients, to connect them with resources, to promote health and not just lack of disease. It is our responsibility in the outpatient pediatric setting to do everything we can to make sure the in-between kids don’t fall through the cracks.
Anjeli Raheja, OMS-IV
Before my rotation, the only exposure I had to pediatric cancers is what I had seen in the media. I thought of beds of sick children, getting poison pumped into their bodies, or rows of hairless infants wrapped up in blankets shivering. When I found out that my first rotation of my fourth year of medical school was going to be in pediatric hematology and oncology, I wanted to be prepared for what I was going to witness. I thought I was going to walk into a clinic where there would be a cloud of despair and hurt. I thought I would see parents and their loved ones crying over devastating news. I thought I was going to see broken children, with broken spirits. That was the exact opposite of what I saw.
From speaking to my fellow peers, I know the perception of pediatric hematology and oncology is one of sadness. Their perception, even though based in goodwill, was severely misconstrued. Working in a pediatric hematology and oncology clinic, I saw true perseverance and hope. I saw strong families working side by side with physicians to come up with the best solution for their child. I saw kids getting to be kids, without the label of that big, nasty, “C” word, cancer, halting their lives.
The resilience of a two-year-old with acute lymphoblastic leukemia or a four-year-old who lost her kidney due to a Wilms tumor, is insurmountable. My first day in clinic, I saw a child on his third cycle of chemotherapy. Even though he had lost about 75% of his hair, and felt a tad bit nauseous, he still came up with these cute little jokes to put a smile on his parents’ faces. That was when I realized that everything I thought about pediatric oncology was completely and utterly wrong.
Greater than the pain, there was an overwhelming sense of togetherness and community with only one goal: to keep hope alive. As the patients, their families and their medical teams trekked through countless days of therapy, where they would have some good days, and some not so good days, they always kept that one goal in mind. After seeing this time and time again, I can confidently say, that these children have truly been an inspiration to me, and I honestly feel very grateful that they let me take a quick glance into their journeys.
September 16-19, 2016
Anaheim Convention Center