Pediatrics – SINCERELY, DR. DAN

Shaking Hands

An interesting article on the internet caught my eye this morning. It was a survey of infectious disease experts and epidemiologists who were asked if they would ever resume typical interpersonal behaviors such as hugging and shaking hands as well as attending crowded events such as concerts, religious services and traveling on airplanes.

It made me think of my regular routine which I followed for 40 years as a pediatrician. Who knows how I would adapt to the present situation if I were still working? Since the patients would be waiting for me in the exam rooms, I would always knock on the door, just as a polite formality in case they were still in the process of undressing.

Since the patients would be waiting for me in the exam rooms, I would always knock on the door, just as a polite formality in case they were still in the process of undressing.

As I entered, depending on the child’s age, I would say hello to the child already sitting on the exam table and would extend my hand. If this were the first visit, I would always introduce myself as “Dr. Kraft.”

In an instant, I was able to assess the situation. I could observe the comfort or discomfort of the patient from their verbal and non-verbal cues.

Very quickly thereafter, I would address the parent or parents and ask them why they were there. To the parents, I would always say “I’m Dan Kraft.” Many parents would later tell me that they appreciated that I paid attention first to their child, and that they liked that I introduced myself using my first name.

While this was happening, I would walk a few feet to the sink and wash my hands and dry them carefully. I would sometimes ask the parents if they noticed that I washed my hands before examining their child. I expected that everyone would be aware of my routine, but only about half of the parents stated that they had noticed.

**I would wash my hands, and watch if the parents would notice this**

Over the years, my routine would be tweaked slightly. I would make a point of swabbing my stethoscope before using placing it on a patient’s chest. Soon before I retired, I abandoned wearing a tie because of studies claiming that ties could spread infection from one patient to another.

**I would clean my stethoscope before each patient**

Where did I learn this particular routine? When I was growing up, my uncle was becoming a pediatrician. Whenever I would visit him, I would enjoy following him on rounds and in his office visits. I witnessed his friendly interaction with his patients and their families. Early on, I knew that I wanted to become a pediatrician and follow in his footsteps. Little did I know that I had subconsciously incorporated his rituals into my daily practice.

At one point in my career, my practice was being courted by a larger practice from Miami. We would have been the first practice in our county to join this busy practice. Initially I had my misgivings because I knew that they were such a high-volume, fast-paced operation. It probably would been a drastic change for our office which was slower and where we devoted more time to each patient and his or her family.

As part of the process, I went to Miami to observe the “style” of the practice. I spent the whole day with one of the senior members of their practice to determine whether our practices were compatible. In the course of a busy afternoon, I noticed that the doctor did not wash his hands even once either in front of the patients or in between each visit. It was partly due to his seeing twice as many patients as we would be seeing during that time period.

I was so turned off by the pace of the office that I decided that our practices would not be compatible. Despite reassurances to the contrary, we would probably have been expected to adjust to the increased volume. When I realized that the doctor was “processing” patients so quickly that he didn’t have time to wash his hands before examining each patient, I concluded that the merger was not going to happen.

I returned to my office and informed my partners that we would stay independent and not join the larger group. I never regretted that decision. I never wanted to compromise the style of seeing patients that I had chosen early in my career. Our patient satisfaction scores were always high because patients could tell that we were sincerely interested in their care. And equally important, the job satisfaction of the doctors and nurse practitioners who worked in our office was an important priority.

I can honestly say that it rarely happened that even on a super-busy day, I wouldn’t come home and tell my wife that it had been a good day. Looking back on those 35 years, I was happy that I had set the tone and the pace of the practice which ensured that it was a workplace that I was proud to have created.

My Worst Visual Memory

Bonus/Extra, English version

WARNING: DESCRIPTION OF GRAPHIC VIOLENCE

My fellow pediatric residents at a municipal hospital in NYC in the mid-70s probably remember this horrible story very well.

A child was brought to the emergency room with extensive burns to one side of the face. She must have been two or three years old. The smell of burned flesh and hair was horrific and her pain was beyond belief. The other doctors and I had to hold back our tears as best as we could.

My job was to take a history from the mother who had accompanied the child in the ambulance. She told me that because the child had “misbehaved,” the father tied her to the bedroom radiator. When the heat later came on later at night, the right side of the child’s face was stuck between the radiator and the wall, and she wasn’t able to move away from the heat. By the time that her mother realized that her right eye and cheek had been melted away and scorched, it was too late.

This child became a long-term patient on the pediatric ward. She required numerous plastic surgical procedures and was eventually fitted with a removable prosthesis which fit well into the reconstructed area of her face. It had a beautiful false eye which matched well with her other side.

One time as she was playing in the children’s playroom, she became angry at one of the other children. In a fit of rage, she yanked off her facial prosthesis and threw it on the floor. There it sat for a minute, staring up at us with that almost realistic-looking eye, until her nurse picked it up and replaced it.

I’ve often wondered how a child or for that matter anyone could ever recover from such a horrible intentional act of violence.

I can still picture that eye and cheek lying on the floor. Not my favorite visual memory!

Implantation

English version, Humor

The other day my wife and I had dinner with an old friend and her husband who now live most of the year in another state. She and I go “way back” almost forty years since she was the first doctor that I hired for my pediatric practice. It was inevitable during these reunions I would be reminded of stories from the past.

I’ve written before that one of the most successful ways of attracting new patients was for expectant parents to come to our office to meet us even before their child was born. These “prenatal consultations,” scheduled at the end of the day, gave us time to know each other to see if we would be “a good fit”.

One family had moved from Broward County to Palm Beach County. They had one child and another one on the way. During our visit, I thought I heard them say that their first child was born “by implantation” and I proceeded to tell them that my first two children were adopted and the third was conceived “biologically.”

After I went on and on saying that I had many children in my practice with all sorts of different family origins, he looked at me strangely and asked, “What are you talking about?”

“Well, some kids have surrogate mothers, others are adopted and some are biological. Some families have two mommies, some have two daddies.” I continued on with a description of my practice and how I was glad that we had a varied demographic.

“All I said was that my first child was born in Plantation,” he said.

“Oh, Plantation, Florida,” I replied, feeling very stupid that I had misheard him completely.

We laughed about it and I wondered how ridiculous I must have sounded.

It turned out that they ultimately chose my practice when their baby was born. I continued to follow both of their children throughout their teenage years. Whenever I saw their family, I would fondly remember them as the “Implantation Family.”

Male Pediatricians

English version

One day, I was examining an eight-year-old boy. As I entered the exam room and introduced myself, he said, “I didn’t know that doctors could be men.”

Apparently, in all the years that he had coming to our practice, he had only seen the women “providers.” He wasn’t aware of how things had changed so much during my career.

Fifty years ago when I started medical school, my class of 80 students included 16 women (20%) which at that time was higher than the national average. When I finished my pediatric residency in 1978, my specialty was still dominated by men. Over the years, as more women went into medicine, pediatrics became a specialty which attracted many more women than men.

Now when I go to a pediatrics conference, I am surrounded by mostly women. The majority of the men are typically old timers like me.

***Old-timers like me (that’s not me!)***

High Fevers

English version

In the early days of my pediatric practice when I was working completely by myself, it was very common to receive calls from patients at all hours of the night. Some of these calls were legitimate emergencies; others were matters which could have been addressed during normal office hours.

However, it is a known fact in pediatrics that children’s fevers are often higher during the evening and night hours. It wasn’t unusual for new parents to become alarmed at the first sign of a rising temperature, so I would often receive these “fever calls” just as I was ready to go to bed.

One call, however, humbled me.

A friend who was actually the lawyer for our practice called me and the answering service put it through to me immediately.
“My daughter has a fever of 107!” he screamed.

Trying to calm him down, I replied, “No, you mean 100.7, don’t you?”

“No, I took it twice and it’s 107.1……….. and now she’s having a seizure!” he yelled.

“O.K.” I answered, calmly, “Call 911 and bring her to the hospital immediately.”

It turned out that she was developing chicken pox encephalitis and she was running high fevers during the first three days of her hospitalization.

I learned from that encounter that sometimes an anxious parent is accurate. Even in panic mode, parents can be right.

Prenatal Consultations

English version

During my long career as a pediatrician in Palm Beach County, Florida, I welcomed parents to our office to meet the doctors before the birth of their baby. Not only was it a great marketing tool because we were the first in the area to do what we called “newborn consultations,” but it also gave parents a chance to see for the first time what it would be like to come to a pediatrician’s office.

We scheduled these appointments at the end of the day so that working parents would be able to attend. Because of this, the expectant parents sometimes had to wait a while before we brought them into the exam rooms. In this way, they learned why there might be a wait before they were seen after their baby was born.

Parents asked every sort of question at these visits. One which stood out was from a father who asked me if I had a mortgage on my house, which I found out was his way of asking if I were going to be around for the whole time that his child would be coming to our office. Since it was totally illogical, I was able to laugh about the question with him.

The wonderful long-term relationships that I built with many families over the years often came from these initial meetings. Parents often remembered every word I said. When I came to see them at the hospital after the baby was born, the connection was solidified even further.

The joy of being a pediatrician was in these longstanding relations of trust and communication with the parents. It’s a given that the kids are cute, fun to examine and thankfully most of the time, healthy, but the bonds which form with the whole family are what makes pediatrics such a wonderful specialty. In my case, these bonds were often established even before the babies were born!

Foreign Languages Overheard

Bonus/Extra, English version, Humor

When I was practicing pediatrics in Florida, I had this experience more than once. Some new patients wouldn’t know that I spoke Spanish, so often couples or a mother and a grandmother would be speaking Spanish between themselves, sometimes making derogatory or critical comments about me. I would just listen and not reveal that I understood everything they were saying until finally I would ask, “¿No sabían qué yo era puertoriqueno? (“Didn’t you know that I’m Puerto Rican?”)

Their mouths would always drop. I wish I could have had a picture of that moment! Then they would ask me where in Puerto Rico I was from. I would always answer “Ponce” even though I was never in that part of PR. We would then have a good laugh and they would be wondering what they had previously said. Most of the time it was just innocent criticism like, “This new doctor doesn’t know what he’s talking about!”

R.I.P.: Costco Photo Center

English version

When I recently learned that the Costco Photo Centers were being phased out, I wept along with many other photographers who had counted on them to create beautiful enlargements. Let me explain why I was one of their favorite customers.

Until I retired six years ago, I was a pediatrician in Palm Beach County, Florida for almost 35 years. In the 10 years before I stopped working, my wife and I had been traveling all over the world and I would display some of my favorite photos on the walls of my offices. My patients were often surprised when I told them that the enlargements were done by Costco.

Many years ago, when my young patients and their parents began to admire my pictures, I decided to give them copies of my favorites in simple 5 x 7 cardboard mattes. I would order 500 at a time at Costco every few months.

Many patients would tell me that they posted their “Dr. Kraft pictures” on the kids’ bedroom walls. I would make a geography lesson out of it for the school-age children. Each picture came with the assignment to research where the picture was taken. Some parents even shyly asked if they could have one from my selection basket.

When we were traveling, I would carry an assortment of these simply-framed pictures to give away to children and adults in exchange for letting me take their pictures. I have photos of children and adults holding my pictures from our trips to China, Bali, Japan and Peru. It’s a great icebreaker! When a hotel clerk or flight attendant has been especially kind, I also give them one of my enlargements. It’s my favorite way of thanking them for their special service. They often told me that they appreciated it more than any monetary gift.

Until Costco decided to eliminate their in-store photo centers, their employees would ask where we were going next and when I was going to order another large batch of pictures. That is not going to happen anymore since I’m retired, but I do have some new favorites which I will enlarge for my home through mail order. When our traveling eventually resumes, I will continue to bring some pictures along with me to give out wherever we go.

Now whenever I go to Costco, I see my old patients who remind me of the photos that they still have from their visits to my office. I am happy to see that this is part of my legacy as their pediatrician in my community.

The Passenger Next to Me

English version, Humor

I was sitting in the window seat next to two small children whose parents were seated on the other side of the aisle with their older child. (As in me/3 y.o./4 y.o./AISLE/father/6 y.o./mother.)

***Seat configuration on the airplane***

As the three-hour flight continued, it became increasingly obvious that the little boy next to me had to go to the bathroom. I suggested nicely to the father that I thought it would be a good idea for him to take the child to the bathroom before the plane landed.

The father asked the boy if he could hold it in. And then he made the mistake of believing him when he said yes! By the time that the plane was getting ready to land, the boy had a nasty explosion with poop oozing out of his shorts. It was too late at that point for the father to take him to the bathroom and he threw me a blanket, asking me to cover up the mess.

I reluctantly complied with his request, but I said to him, “The next time a pediatrician tells you that your kid has to poop, listen to him. We’re experts in this area.”

The Other Dr. Kraft

Bonus/Extra, English version, Humor

Very early in my career when I was just a young pediatrician in Palm Beach county, I was in an exam room seeing a patient when my nurse knocked on the door.

“There’s someone on the phone who said she needs to talk to you, but I had trouble understanding her because of her accent.”

“Can it wait?” I asked.

“No, she said it’s very important. “

“Hello, this is Dr. Kraft,” I said as I picked up the phone.

“Dr. Kraft, ” my caller said with a very heavily accented pronunciation.

“My name is xxxxxx xxxxxx from the XXX spa in Palm Beach,” she said, expecting me to recognize her name or her spa’s name.

“I’ve heard about you from so many of my clients on the Island.”

That’s Palm Beach lingo for some who wants you to know that they are from the town of Palm Beach, the island off the coast from the mainland West Palm Beach.

***The Town of Palm Beach, known as “The Island,” just off the coastal city of West Palm Beach***

I did have a few families who lived “on the Island,” as they loved to call their ritzy enclave, but I already was getting the feeling she was mistaken if she was talking about clients in a spa.

“How can I help you?” I asked.

“I wanted to meet you personally,” she continued, “since I’ve heard you do such mahvelous things with breasts” (with the emphasis on the word “mahvelous“). It was then that it clicked.

There was another doctor with the name Craft who was a plastic surgeon. Our paths never did cross in my 35 years in practice, for obvious reasons, but I always chuckled when I heard when a patient had been referred to me by someone on “the Island.”

I still have my own personal reason for laughing when I think of Billy Crystal and his SNL “Mahvelous” skit.