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“Don’t let what is urgent make you lose sight of what is important.”
— Julius Richmond, MD, pediatrician, former US Surgeon General and first national director of the Head Start program
Bad guys win.
Optimism’s wearing thin.
Things are spinning out of control.
Cynicism’s all the fad.
World events could make us mad
as hatters.
Almost every day
some underpinning slips away.
These aren’t laughing matters.
“Laughing Matters” — Bette Midler (Dick Gallagher, Mark Waldrop), 1988
“We must always consider the person.”
— Pope Francis, current Pope of the Catholic Church, 2013
It was turning into one of those afternoons in the office. Back-to-back acute sick visits that defied convention: nausea and abdominal pain, hematemesis and right lower quadrant pain and difficulty breathing with light-headedness. All with families in tow (or, of course, available by cellphone), and stunning truly only in the sequential nature of the visits. The patients were unexpectedly pregnant, factitious, and anxious — sequentially not individually.
William T. Gerson
Needless to say, the scheduled 6-year-old well visit to follow waited slightly longer than I am comfortable with. After apologies, I asked the child if he enjoyed his summer and if he was excited by the new school year. Once affirmatively answered, we moved on to the rest of the visit, my thoughts I must admit still somewhat reflecting on the three still unfolding previous visits. In closing, I asked him if he had any further questions of me.
“Yes,” he said. “Do you love being a doctor?”
After emphatically answering in the affirmative, I left the room musing the afternoon’s events. I don’t remember being asked quite so directly by a patient of any age, let alone a 6-year-old, as to my well-being in my chosen profession. The juxtaposition of the recognition that I did love what I do and the innocent youthful question reaffirmed the many privileges we are granted as physicians. The challenges and vagaries of my office schedule and my frustration at the time limitations sometimes imposed quickly dissipated, as did the time before my next patient.
While my day took on a different tenor, as I could see the rewards of my office practice in the individual encounters with patients and their families, the challenge of the larger context of pediatric care was left to ponder at the end of the office day. How do we individually and collectively advocate for all of our children and promote their lifelong health and happiness?
Attempt to stay positive
Our success in promoting the well-being of our nation’s children is a critical piece in securing a healthy future for our society. At this time of national ineptitude in addressing the real problems in our land, let alone paying the bills for services already rendered, or even entertaining a civil political conversation — it is far too easy to be overcome by cynicism and to focus on the urgent. The important fact remains that unless a collective voice is found for an agenda for children, another generation will founder unnecessarily.
We have managed to create a reality in which the few, among whom have done well financially, can lead a far too separate life from the vast many who have not. With the ability to purchase high-quality child care, education, personal safety and generational success, the sense of shared mission or purpose is diminished, living mostly in nostalgic aphorisms. It is hard to know whether to laugh or cry.
A major investment in the future of our children will take not only the professional commitment of pediatricians, child health advocates, educators and the scientific community, but also the harnessing of the political will to enter the fray. Let’s face it — the political side of the equation is an ugly place. Corrupted by money and incapacitated by self-righteous purity, our system of government is losing the consent of the governed. Our children may not be better off than their parents … the end of the American Dream. We accept the presence of poverty, even among the children of our country, with hardly a serious discussion, and allow our elected officials to demonize not only the programs in place to assist those in need, but also more disheartening the individual children who are impoverished. There is evil among us.
As advocates for children, where are our strengths? As pediatricians, they are our offices, neighborhoods and greater communities. Our strength grows from our connections with local advocates for children in schools and in local and state children’s services and spreads to our children’s hospitals and state and national professional organizations. It includes local and national universities and the National Institute of Child Health and Human Development in hopes of creating a cohesive research effort to focus on the developing child in real time in our communities.
Improvement needed to promote well-being
The urgency is clear and overwhelming. However, the important can be advocated for and can be solved. We must move beyond the simplistic arguments of services and programs designed to improve school readiness to the more robust description of plans to improve the health and well-being of our patients. Investing in our children is not only about school success and should not be measured only by this construct. The investment in our children needs to be seen and, ultimately, measured in terms of health outcomes (emphasizing wellness broadly defined), disease prevention and community strength. We must present an evidence-based, community-located, comprehensive and optimistic program for the well-being of our children. If a pope can graciously move beyond current dogma and refocus on a centuries-old mission statement of compassion, then there is hope for rededication to a much younger American Dream that proposes a future for our children more enriched than their parents.
Disclosure: Gerson reports no relevant financial disclosures.