What’s in a Doctor’s What’s in a Doctor’s Bag?Bag?

Maria O. Stanislaw, DOMaria O. Stanislaw, DO

Marshfield Clinic, PGY2Marshfield Clinic, PGY2

Marshfield, WIMarshfield, WI

AdvocacyAdvocacy

Advocacy is the pursuit of influencing Advocacy is the pursuit of influencing outcomes that directly affect people’s outcomes that directly affect people’s current lives. current lives.

Marshfield Clinic’s Pediatrics Residency Marshfield Clinic’s Pediatrics Residency program requires an advocacy or research program requires an advocacy or research project before graduation. project before graduation.

My project is called What’s in a Doctor’s My project is called What’s in a Doctor’s Bag?Bag?

The Summer The Summer Day by Mary Day by Mary

OliverOliver

““Tell me, what is it Tell me, what is it you plan to do with you plan to do with your one wild and your one wild and precious life?”precious life?”

Walk a Mile in their ShoesWalk a Mile in their Shoes

ThreateningThreatening UncomfortableUncomfortable Restricted movementRestricted movement Separated from parentsSeparated from parents Viewed as a punishmentViewed as a punishment Undressing in-front of strangers Undressing in-front of strangers Memories of shots, gagging, forcibly Memories of shots, gagging, forcibly

restrained…restrained…

Routine visits have potential to produce Routine visits have potential to produce stressstress

1990. Goldberg, L.; Gaynard, L.; and Wolfer, J. Helping Children Cope with health-care procedures. 1990. Goldberg, L.; Gaynard, L.; and Wolfer, J. Helping Children Cope with health-care procedures. Contemporary Pediatrics, March. 141-160.Contemporary Pediatrics, March. 141-160.

Poof!!! Be GonePoof!!! Be Gone

Prelogical thinking prevails between 2 and 6 yo. Prelogical thinking prevails between 2 and 6 yo. Children use their immediate spatial and Children use their immediate spatial and

temporal cues to determine their realitytemporal cues to determine their reality Doctor visits can be viewed as a punishment Doctor visits can be viewed as a punishment

implemented by a villain (the doctor)implemented by a villain (the doctor) By introducing children to medicine in a non-By introducing children to medicine in a non-

threatening manner, we can remove some of threatening manner, we can remove some of their misconceived perceptions. their misconceived perceptions.

2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215.2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215.

What are the goals?What are the goals?

Don’t Worry, Be HappyDon’t Worry, Be Happy Take the unknown out of the well Take the unknown out of the well

child visitschild visits

41 mothers with toddlers routine 41 mothers with toddlers routine immunizationsimmunizations

If children were informed before If children were informed before immunizations, the shots were less immunizations, the shots were less distressingdistressing

They had the chance of using self-They had the chance of using self-oriented strategies rather than oriented strategies rather than avoidant coping strategies. avoidant coping strategies.

2008. Favez, N. and Reichert, M. Toddler’ Adjustment to the Stress of Immunizations. 2008. Favez, N. and Reichert, M. Toddler’ Adjustment to the Stress of Immunizations. Early Child Development v178 n1 p49-64. Early Child Development v178 n1 p49-64.

Practice Makes PerfectPractice Makes Perfect

Make believe medical Make believe medical consultation for preschoolers consultation for preschoolers reduces anxiety when visiting reduces anxiety when visiting doctors.doctors.

2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215.2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215.

Proactive approach to healthProactive approach to health

Decrease barriers Decrease barriers to healthcareto healthcare

Invested interest Invested interest in their own healthin their own health

Up-to-date on Up-to-date on immunizationsimmunizations

Well child visitsWell child visits

Early career choicesEarly career choices

Studies show that Studies show that career aspiration career aspiration can begin as early can begin as early as elementary as elementary schoolschool

It’s never to early to It’s never to early to spark an interest in spark an interest in a medical career a medical career

2000. Jessee, Peggy; Wilson, Heidi. Childhood ducation. Vol 76, issue 4, 2000. Jessee, Peggy; Wilson, Heidi. Childhood ducation. Vol 76, issue 4, p215.p215.

Have fun!Have fun!

Play is a medium to Play is a medium to learn about the learn about the world- Piaget, world- Piaget, EricksonErickson

Switch form passive Switch form passive observer to active observer to active participantparticipant

Conquer fearsConquer fears

1988. Oremland, E. Mastering development and 1988. Oremland, E. Mastering development and critical experiences through play and other critical experiences through play and other expressive behaviors in childhood. Children’s expressive behaviors in childhood. Children’s Health Care, 16 (3), p150-156. Health Care, 16 (3), p150-156.

My PlanMy Plan Target population: Target population:

Head Start to 3Head Start to 3thth grade grade Rural Wisconsin childrenRural Wisconsin children 20 minute presentation covering the basics20 minute presentation covering the basics Split into small groupsSplit into small groups Typical medical equipment in a well child visitTypical medical equipment in a well child visit Name, functionName, function Identify body partsIdentify body parts Hands-on approachHands-on approach Children are sent home with an encouraging Children are sent home with an encouraging

flyer for parents to read and discussflyer for parents to read and discuss

Overall GoalsOverall Goals

Encourage, guide, ask questions, answer Encourage, guide, ask questions, answer questions, respond to concerns and have questions, respond to concerns and have some fun…some fun…

OutcomesOutcomes

No formal measureNo formal measure Plenty of smiles and hugsPlenty of smiles and hugs Positive feedback from parentsPositive feedback from parents Reminder about why I’m in primary careReminder about why I’m in primary care

Long-term PlansLong-term Plans

1 1/2 years in Marshfield 1 1/2 years in Marshfield Continue the program until my graduation Continue the program until my graduation

and then set up a similar program at my and then set up a similar program at my future practice sitefuture practice site

Future plans: To include surrounding small Future plans: To include surrounding small townstowns

Perception is EverythingPerception is Everything A study in rural Ireland focused on how the A study in rural Ireland focused on how the

process of health visits in homes and schools process of health visits in homes and schools changed parents’ perceptions medical carechanged parents’ perceptions medical care

Parental perceptions of being supported were Parental perceptions of being supported were exemplified by:exemplified by: Increased confidenceIncreased confidence in infant care in infant care Reduced anxietyReduced anxiety InIncreases in knowledgecreases in knowledge A sense of A sense of personal competencepersonal competence in parenting in parenting

practicespractices Reduced isolationReduced isolation

McIntosh, Jean. The process of health visiting and its contribution to parental support in the McIntosh, Jean. The process of health visiting and its contribution to parental support in the starting well demonstration project. Health and Social Care in the Community 15(1), 77-85. starting well demonstration project. Health and Social Care in the Community 15(1), 77-85.

““The specific leadership of pediatricians is The specific leadership of pediatricians is often key in overcoming political and often key in overcoming political and cultural barriers.” cultural barriers.”

Grason, Holly. Pediatrician led community child health initiatives. Pediatrics vol 103 No. 6. June 1999.Grason, Holly. Pediatrician led community child health initiatives. Pediatrics vol 103 No. 6. June 1999.

How can you repeat this project?How can you repeat this project?

What do you advocate for?What do you advocate for? Where is your passion?Where is your passion? Does your residency have a similar project Does your residency have a similar project

requirement? requirement? What simple thing can you do TODAY that What simple thing can you do TODAY that

will have positive outcome on will have positive outcome on TOMORROW?TOMORROW?

““What do you plan to do with your one What do you plan to do with your one wild and precious life?”wild and precious life?”

Thank you for your time. Any questions?Thank you for your time. Any questions?