A Hero’s Halloween

dress_up_playI have nothing against superheroes.  We have plenty of comic book heroes around our house.  However, when my son wanted to dress as a real-life hero for Halloween, I was discouraged to find that our local Halloween superstore had no such costumes.  With walls full of spandex suits and capes, racks of shields, swords, and guns, we were simply looking for a firefighter helmet.  N outgrew his firefighter costume from last year and so we were looking for an updated version.  The store clerk looked at me confused and then informed us that they did not sell firefighter costumes.  I scanned around me for other everyday heroes: police officers, nurses, doctors, and teachers.  No, no, no, and no.

I remember dressing as a doctor when I was younger, as I knew that was what I wanted to be when I grew up.  Halloween gave me an outlet to try on this profession in a fun way!  Those were the first scrubs I ever wore and I remember feeling proud to dress like my doctor.  N feels the same about our local firemen and tells me often that he wants to drive a fire truck when he “gets bigger.”  So I did not let the costume store stop him and we eventually found a firefighter costume for him elsewhere.  He has worn it in his imaginative play many nights each week leading up to Halloween and long after his candy loot is gone, he will continue playing this role.

I know that soon he will likely want to dress like Spiderman or Captain America, but I’m enjoying his current appreciation for the heroes he sees in his everyday life and to whom he can aspire.

 

For last minute Halloween costume ideas, check out my Pinterest costume board here.

What was your favorite childhood Halloween costume?

Doctoring on the Streets of Philadelphia

digger_Philly_streetsOne of the things I love about my pediatrics practice is that I live in the community where I work.  Parents are often asking me for recommendations for daycare, clothing stores, and weekend activities.  We share resources with each other and I am always excited to share my favorite places with my patients’ families.

Not only do we talk about community resources, but we often run into each other while visiting these sites.  One day I was telling the owner of Cloth that I tell patients about her store for cloth diapers, breastfeeding and baby-wearing supplies when a patient walked in the door at that very moment!  I have seen patients at grocery stores, boutiques, concerts, department stores, playgrounds, farmers markets, restaurants, and even while visiting Santa.  Sometimes I am alone and sometimes they are introduced to my family.  I enjoy getting to share my family with my patients, although I am often fearful that they will catch us mid-tantrum.  It never fails that the day I decide to run to Target with a ponytail and sweatpants, I will see at least 2 patients.  On the days that I am bribing my toddler with junk food, I cross my fingers that I don’t see patients who I have admonished for their unhealthy snacking.

Pediatrician parents don’t always follow all of the advice that we give out and we know that our patients don’t either.  My colleagues and I have discussed what topics we can’t help but comment on when we see patients out in the community and which we are willing to let slide.  Our topics included things like car seats, bike helmets, sunscreen, and seat belts, showing that we weren’t willing to be polite when it came to child safety!  Similarly, we would want others to tell us if our children were at risk.  We agreed though that things that are more personal in nature, such as breastfeeding, ear-piercing, and discipline were more tricky to address and often avoided unless advice was solicited.

While my patients may see me disheveled or my kids misbehaving, they will see a real family like theirs.  I think they appreciate knowing that while there may be many things about us that are different, there are things about all families that are universal.

Ebola in My Newsfeed and in My Clinic

It seems everywhere I go and look I see reports about Ebola.  After reading through a number of essays online that were shared in my Facebook newsfeed, I couldn’t help but respond.

An Op Ed by Frank Bruni in the New York Times encouraged us not to panic about Ebola, but rather observe a number of safety measures that most pediatricians counsel about regularly, such as seat belts, flu shots, and gun control.  Many other news media, such as this New Yorker article, warned against the spread of fear that Ebola is causing as the coverage of this epidemic picks up.  Over and over again I read messages that told me don’t fear Ebola, fear these other more common and realistic threats.  And yet I couldn’t help but feel nagging thoughts of can’t I fear both and what’s wrong with a little fear about a deadly disease?

While I practice prudence, as Frank Bruni encourages, and immunize my children, insist on car seats and bike helmets, and maintain a gun-free home, I also spend a portion of my week worrying about things that are far outside my immediate control, and right now that includes Ebola.  As a physician, I can’t just dismiss a major public health threat.  After all, the CDC initially told me that there was nothing to worry about and that things were under control, then two nurses were diagnosed.  The news repeatedly states that there is a concern about Ebola spreading to health care workers, which is my profession.  There are plans to regionalize care of Ebola patients, which includes participation of my hospital.  So I will still continue to get my annual flu shot, wear my seat belt, and wash my hands, but I will also stay informed about what is happening with Ebola and maintain a healthy dose of fear.

And what is wrong with a little fear?  My practice has seen an increased number of phone calls related to concerns about Ebola.  People who have never traveled outside the country and have no contact with international travelers are coming in worried that they have Ebola.  People misunderstand how Ebola is spread and how it can and cannot be treated.  What I have found though is that after I educate them about Ebola, parents are still interested in protecting their children from other diseases, such as flu, HPV, and pneumococcus.  It seems that their fear regarding deadly Ebola infections reminded them that there are other potentially deadly infections out there that we CAN immunize against.  When bombarded with news coverage about a scary disease and feeling helpless, it makes parents regain some sense of control in acting to protect their families by immunizing them against real threats.  So while I don’t want the media to scare families or spread misinformation, I think the messages of being attentive, preventing the spread of infections, and being forthcoming with your medical providers are important.  In my clinic, Ebola has motivated many parents to make healthy decisions for their children, not only in giving immunizations but talking about hand-washing, staying home from school when sick, and not sharing beverages.

One of the best pieces of Ebola coverage that I have read is this one from Arthur Caplan, PhD, at NYU, looking at the situation from a bioethics perspective.  As he points out, if we fight Ebola with an “expert, regional response” and start to agree on what quarantine means, we don’t have to fear Ebola and can go back to worrying about things like the flu.  In my practice, I will continue to screen patients appropriately who may be at risk for this awful infection, debunk myths about Ebola, help parents focus on the things that they can do to protect their children from all illnesses, and maintain an intellectual curiosity about how our country responds to this global public health threat.

 

 

The above opinions are my own and do not represent my employer.

For Healthcare workers:  See here for tightened guidance for US healthcare workers on personal protective equipment for Ebola, released October 20, 2014.

One Year

birthdaybirthday_1

One year ago we welcomed a baby girl, who now is starting to walk and talk and teach us about the person she is.  It has been an amazing year and we have been enjoying celebrating all week with the little girl who made it so.

Observations of the birthday girl:

Teeth: 2

Words: Uh-oh, Dada, Up, Duck

Loves:  animals and her brother

Favorite foods:  mashed potatoes and milk

Favorite part of bedtime: brushing teeth

Party theme: milk and cookies

What she is getting for her 1st birthday: a flu shot

Happy Birthday, G!

 

The Germs We Wear

Fall_2014As pediatricians, we know that we will be exposed to a variety of germs throughout the day and this is never more obvious than during flu season when we see coughing patient after coughing patient.  With young children at home though, many of us wonder what the risk is of bringing home these germs on our clothing and belongings.  Informally I have polled my colleagues and found that we all have different after work rituals to decontaminate ourselves, varying from nothing to showering and changing clothes.  I’ll admit that my personal practice differs depending on the day and a variety of factors, including practicality and convenience.

It is hard to know what the actual risk is though, since different germs live for varying durations outside the human body and some live better on hard surfaces than fabrics.  It has long been known that doctors’ white coats can be transmitters of bacteria, especially in surgical sub-specialties and inpatient units.  Similarly, it has been shown that ties are frequently carriers of bacteria, as they dangle over patients and drape across a variety of surfaces.  One 2002 study showed that orthopedic surgeon’s ties had the same bacteria found in wound infections of patients.  Ok, so I don’t wear a white coat or a tie… am I safe?  Well, as a resident I wore scrubs and one 2011 study showed that 60% of hospital nurse and physician uniforms are colonized with bacteria.  The good part about wearing scrubs, even if colonized with bacteria, was that when I came home I immediately took them off and washed them.  In contrast, I now wear my regular clothing to work and the divide between home and work attire is more blurry.  While in general my work clothes are separate from my everyday leisure clothes, there is definitely some cross-over.  There are also many times when I go straight from work to events or activities with my children, exposing them to whatever is still on me.

While I found many studies suggesting that there are bacteria all over my clothes and ID badge, there isn’t anything that explains what risk there is of this bacteria causing infection in others, whether patients or my children.  Instead of worrying about what I am wearing, the Society for Healthcare Epidemiology of America (SHEA) suggested, in a 2014 JAMA article, a few tips, including being bare below the elbows, washing hands, and cleaning stethoscopes and ID badges regularly.

So, if I try to be bare below my elbows (which I often do by pushing up my sleeves), avoid white coats and ties, clean my accessories, and wash my hands, then does it matter what I am wearing beyond that?  Well, one 2004 study in the Journal of Infection Control looked at how different fabric materials carried pathogenic bacteria and found that polyester, acrylic, and wool were much worse that cotton (> 80% vs < 10%).  Great… more reason to justify my cheap, cotton t-shirts.  How do patients feel about my casual, cotton bare-below-the-elbow attire though?  Turns out that in the UK, where white coats are banned, patients have reported preference for scrubs in inpatient settings and formal attire in outpatient settings, however, preferences changed once patients understood why these policies were in place.

I have worked in settings with a variety of dress code restrictions due to this issue, including a ban on white coats, wedding rings, and open-toed shoes.  While my current work dress code is flexible, I tend to take a middle of the road approach and follow many of the recommendations of SHEA.  As a pediatrician, I also think about the risk of bringing home things like lice and scabies, so I often have a no hugging and no hair touching (mine, not the patient’s) policy.  Overall though, I worry less about what I’m wearing when and more about hand hygiene.  I would encourage everyone to wash their hands more this Fall and rest assured that I will too.

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