Pediatrics
A NextGen Pathways in Medicine
Article
By Serene Chen
By his easy mannerisms, one could easily imagine Dr. Sean Palfrey as the “cool” grandfather that helps his grandchildren build forts in the living room out of sofa cushions. A real grandparent to two small children, he has taken care of countless others and families as a pediatrics physician and professor of Pediatrics and Public Health at Boston University’s Boston Medical Center.
Focused on treating younger patients, pediatrics is one of the few specialties categorized by the age group of its patient instead of bodily systems or specific methods and approaches. Therefore, these physicians need to cover a much wider range of diseases, not only the “early diseases” but also others that are not conventionally associated with childhood. In a younger patient population, the same diseases have different incidences and symptoms. Since the patients are less mature they have weaker immune systems rendering them more vulnerable to infections.“ Simply put, their systems work a little differently,” says Dr. Palfrey. Due to the wide range of knowledge required, pediatric physicians often consult specialist teams.
Since the actual process of development is extremely complicated, the growth of a healthy individual requires more than mere protection of the bodily systems. Similar to family medicine practitioners, pediatricians view physical health as only one aspect of their practice. Pediatric physicians must also concern themselves with the mental health, education, nutrition, environmental health and safety of their patients. It is not difficult to imagine why pediatricians are highly prevention oriented, just recall the ubiquity of electric outlets and paperclips in any home. As Dr. Palfrey reiterates, keeping the environment from harming their patients and their patients from harming themselves becomes imperative for pediatricians, especially considering how “any little bit can impact children with potentially long-term effects.”
Dr. Sean Palfrey, Professor of Pediatrics
and Public Health at Boston Medical
Center/
Boston University
Dr. Palfrey notes that primary care has a higher level of difficulty in some respect than emergency medicine especially when dealing with younger patients. Those working in the emergency room or the intensive care unit, for example, fight to keep their patients alive, which is an intense and demanding job. However, the timeframe for action is short, the options for keeping patients alive are usually few and more obvious, and the physician’s responsibility for each patient is relieved after the first few hours of stabilizing the patient’s condition. On the other hand, primary care, including pediatrics, must assume responsibility for all aspects of their patients’ lives. Keeping an individual in good health throughout development, in the long term, necessitates a wider scope of care and presents a more diverse set of option that may have a tremendous impact as the patient ages.
Working with younger patients further comes with an additional set of challenges such as grappling with the ethical issues surrounding informed consent and the choice to transition from custodial decision to patient decision. In Dr. Palfrey’s experience, parents can sometimes feel uncomfortable bringing up questions, concerns, or plans, making it difficult for physicians to get a grasp on what actions the patients and their families would actually take in light of the physicians’ advice, or under what circumstances the families and patients are more likely to deviate from the physicians’ prescription.
Sometimes, parents’ reservations stem from cultural differences, leaving younger patients caught between the physician’s suggestions and the family’s values. A family from Chinatown, for example, might be using Chinese medicine while simultaneously consulting Western medicine physicians, such that during consultations, “They would smile and nod…but when at home, they would adapt and combine courses” risking lowering the efficacy of the independent treatments. Religion, family structure, traditions, and geography all play a role in affecting adherence, which becomes especially important in pediatrics when patients, as a function of their young ages, often have less say in treatment.
Interestingly one of the best training experiences a pediatrician could have comes not from medical school, but from having children of one’s own. Medical school makes one “hugely skilled and possessing a wide knowledge base, but the approach and priorities of parents becomes better intuited when one is a parent as well as a physician.” Having children teaches one how to give advice and how to incorporate those actions into life. Furthermore, one finally would “understand how difficult it is to take care of children.”
All of the challenges, however, come with their rewards. Thus for those excited by these challenges, pediatrics would make a comfortable fit, as Dr. Palfrey himself discovered after gaining experience in several different fields in science and medicine. He started his career in the basic sciences, in neuropharmacology and neurophysiology. But his love for interaction with individuals and for applying basic science to people “got the best of [him]”, so he decided to pursue an MD/PhD degree Fittingly self-described as “being a nice person as a function of life,” Dr. Palfrey found that he simply has the right temperament: patient, kind, enjoys play, likes parents and children, and “likes to care for anyone from minus-nine-months-old to plus thirty-five years-old—if you count all the interns and residents at the hospital.”