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What back-to-school time means to pediatricians
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Well mama please, your child’s come down with a fatal disease.
Mama said, “Come on you lazy bum now get your butt out of bed!”
“You gotta go back, back, back to school again!”
It’s bye-bye fun, get your homework done,
You better be in by ten,
I gotta go back, back, back to school again.
Whoa, whoa, I gotta go ... back to school again!
— “Back to School Again,” The Four Tops; Writers: Louis St. Louis, Howard Greenfield
Yet another seasonal shift in office practice is upon us. While summer camp and college physicals merge with preseason sports evaluations, back to school — for elementary to high school ages — is a less distinct time in office practice. Because we are tied to an age-based health care maintenance schedule, discussions over school readiness, school performance and learning/behavior issues are more integrated into wellness care than to a designated “back-to-school” time frame. That said, by the time of the first parent-teacher conferences in the fall, those of us in general practice can be certain of an exuberant demand for consultation.
William T. Gerson
No matter how many years you have been in practice, it is hard to be immune to the infectious enthusiasm of early elementary students to the first day of school. Underlying this enthusiasm is a real desire in these children to succeed in the school setting. Keeping both the enthusiasm and the desire going is, of course, the ultimate goal of all involved: students, families, teachers and pediatricians. Ensuring the systems are in place to maximize the potential for a successful outcome is a social responsibility and implicit in a social contract between families, schools and the medical profession.
School-based health may affect performance
Could a change in our office practice improve the possibility that our patients succeed in school? I think we can agree that our offices historically are not designed to ensure wellness in our patients either globally or specifically related to school performance. But they could be if our current health care reform climate would support the dedicated resources to such a comprehensive redesign effort. Building a structure that not only would ensure the public health goals of immunizations and health screenings in the context of school readiness but the more private issues of personal health, attention-deficit/hyperactivity disorder and bullying while transforming less dimensional school-based clinics into a more robust integrated office is a worthwhile venture.
Beyond advocating for effective systems, as pediatricians we also need to be sensitive to the anxieties that often lie just below the surface of our patients and their parents in such a high-stakes endeavor like school. For many of us, who have done well in school and succeeded in this setting, it is easy to be unaware of what it feels like as a parent to be brought to a school meeting and invited to sit in front of a large group of educators, administrators, counselors and told in stark terms how your child is failing. Nor are we likely aware of what it is like as a child to hear your parents then describe your own shortcomings to you. These are loaded conversations at all levels, and our sensitivity to the wide-ranging implications of such events is critical for both anticipatory guidance and counseling.
Difficulties for some students
Further confounding the more typical joy of a new school year is the relatively large minority of our patients and families for which there is no joy in Mudville (Casey at the Bat: A Ballad of the Republic Sung in the Year 1888, by Ernest Thayer). These are individuals for whom the infinite possibilities that school success might mean to some is more clearly better understood as an awareness of the finite limits that indeed exist. These include parents of children with significant intellectual handicaps who are again reminded by the calendar that their child has a much more challenging future than most.
Our patients with significant medical or developmental conditions and their families also often face the arduous task of revising the structural support networks of a new school year or even a new school with the multiple layers of supports — teachers, aides, nurses, psychologists, OT, PT, speech professionals, etc. As well, for our older patients who are questioning their sexual identities or who have identified as Lesbian, Gay, Bisexual and Transgender (LGBT), the start of a school year is often a time of unknown risks and possibilities.
Pediatricians and teachers unite
I cannot fail to mention the inherent, but often overlooked, kinship between pediatrician and teacher (to avoid any perceived conflict, I should mention my wife is an elementary school teacher). We not only share a professional commitment to the well-being of young people, we share a common training in human growth and development, child behavior and educational philosophy. Classroom teachers, however, live that world not in 20- to 60-minute visits as we do, but in day-long aliquots. They deserve our respect and professional cooperation. We must realize that offhand remarks that we make in an office visit might be manipulated once in the school setting. More importantly, we must be clear in our medical assessments, recommending only services for children with special needs that have been outcome validated, and we must be more aware of the classroom implications of all our care suggestions.
I would be remiss if I did not close with thoughts of profound respect for those educators in Oklahoma City, Okla., and Newtown, Conn., who reminded us of true compassion and professionalism by the care of their classrooms in both recent natural and unnatural disasters. I also salute the pediatricians in those communities for their ongoing care, as well as those in the Indian Health Service, who are now dealing with a back-to-school season among Native Americans, in which the federal government is both morally and legally failing to live up to its responsibilities.
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Disclosure: Gerson reports no relevant financial disclosures.