A Note on Advocacy From MIAAP Secretary Gurbaksh Esch, MD

Dear readers,

I always tell people I went into pediatrics because I love to teach. While this is true, I don’t believe it’s completely accurate. As a pediatrician, my primary job is advocacy for the most vulnerable population. I accomplish this through teaching, diagnosing and managing illness, and prevention. Pediatricians advocate for those that cannot speak for themselves, in place of those that cannot articulate their needs, and alongside those that are learning how to discuss needs. We practice advocacy on all levels, because that is what it means to show up for babies and children.

On the individual level, we advocate with parents and patients to encourage primary prevention, have shared decision making in management, and with insurance companies to ensure that care is covered. On the local level, pediatricians interact with their surrounding community to provide holistic care for their patients through referring to community supports and advocating for supports that are limited. On the state and federal level, pediatricians advocate for policies that remove barriers to care and prevent morbidity and mortality of children.

We do this regularly. I want you to remember that the next time you feel that you are not an advocate. It is engrained in the job, in the work of supporting this vulnerable population. Continue to support your patients and families by taking the time to discuss prevention (like vaccines, well visits, wearing helmets, safe sleep, etc). This is your everyday advocacy. Reach out to a local community organization or support to learn more about how you can collaboratively support children and families in your area. We cannot do the work we do alone, we need our surrounding community to lift up babies and kids. Reach out to your local legislator to express the importance of vital care we provide. Speak up for the babies and kids. Encourage your adolescent and young adult patients to advocate for themselves and role model what that looks like. We will not stop advocating for our patients and families, especially when it seems like an uphill battle.

Keep on doing the great work you are doing. If you are interested in structured forms of advocacy, please look out for information on Resident Advocacy Day (May 1st: Register Here) and/or reach out to me (gkshergill27@gmail.com) for other opportunities.

Sincerely,

Gurbaksh Esch, MD MPH FAAP

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Clinical Vignette - Answer for a Chance to win free coffee!

A 2-year-old previously healthy male up to date on immunizations presents to the PCP office with a 6-day history of fevers (Tmax initially 101F), cough, and mild decreased oral intake. His symptoms started with congestion, runny nose, and fevers. Mom had brought him in 5 days ago and PCP had diagnosed him with viral upper respiratory infection. Then, about 2 days ago, he started developing high grade fevers (Tmax 103F) and today mom noticed he was breathing a little fast, so she brought him back in. He is drinking throughout the day, but mom has to keep reminding him to do so. He is voiding regularly. He has no vomiting or diarrhea.

On exam, vitals show T 39C, HR 130, RR 34, and pulse ox 94%. He is mildly tachypneic, but no retractions or increased work of breathing noted. Left lung base has crackles and diminished air entry; all other fields have normal air entry and are without crackles/wheezes. Capillary refill is <2 seconds and his mucous membranes appear moist.

What is the next best step?

Obtain a chest x-ray, CBC, and blood culture for diagnosis.
Empirically treat with high dose amoxicillin and see back in 48 hours.
Admit to the hospital for IV ampicillin, IV fluids, and oxygen.
Obtain a respiratory panel, chest x-ray, and CBC for diagnosis.

Comment your answer on our Instagram post "Clinical Vignette Answer" and TAG A FRIEND + YOUR RESIDENCY PROGRAM/HOSPITAL- correct answers will be entered into a raffle to win a free coffee on MIAAP! Winner chosen on 3/21.

MIAAP Resident Spotlight Q&A: Haley Marber, MD, MS

PGY-3 Child Neurology, University of Michigan

As MIAAP continues its quarterly Resident Spotlight, third-year medical student and MIAAP board member Michal Ruprecht sat down with third-year child neurology resident and fellow MIAAP board member Haley Marber, MD, MS, to learn more about her work and experiences.

MIAAP: Can you tell us about your background and what inspired you to pursue pediatric neurology?

Haley Marber: I focused a lot of my time in medical school on reproductive health advocacy, and for a long time I thought I'd pursue a specialty more directly related to women's health. But of course, I absolutely fell in love with Pediatrics during my clerkship. I came to realize that what I loved the most about reproductive health was being able to guide patients through the most personal decisions about their healthcare, and in particular the ones that don't necessarily have a right or wrong answer. Neurologic disorders have a particular way of impacting the most basic ways people experience the world, and I found it was a speciality where I could really have the type of patient interactions that I loved the most and could dive into a patient's particular values and goals to tailor medical recommendations to them. On a more practical level, I loved that Child Neurology was a good mix of inpatient and outpatient and had a big spectrum of acuity.

Also, what other specialty requires you to carry a big bag of toys around with you? I mean come on, what more could you want!

MIAAP: What has been the most rewarding part of your residency so far?

HM: The experiences in residency that have repeatedly been the most rewarding and most impactful are those where we're able to really take care of a family during a patient's dying process. While we can't ease the unimaginable pain of the loss of a child, we can work with families to make the most compassionate and loving decisions for them based on their values. And we can provide support and guidance and help make final moments as filled with love, and as void of regret, as possible. It is a privilege to be there for those moments in patients' lives, and it is something I never take for granted.

MIAAP: How do you manage work-life balance during residency?

HM: I think it's really important to embrace the shift change: know that someone else is taking excellent care of your patients while you're not there, and leave work at work. I almost never check charts outside of work, and that's been an important boundary for me to keep up.

For me, it's also really important to get out of work on time as much as possible. Aside from the long hours, it just feels demoralizing to stay late every day. Consciously putting effort into working on my efficiency during my first year has been a life-saver, and I rarely leave work late these days.

MIAAP: What has been the biggest challenge you’ve faced, and how did you overcome it?

HM: Burnout! I think this is a challenge that everyone in medicine faces at some point, and I don't know if there is a way to completely overcome it. Some drivers of burnout really do get better with time; as I get more experienced and feel more confident in my decision making. But on the flip side, I don't think anyone ever really gets used to the hours. For me, I think making an effort to do things outside of work even when I feel like I have no time has been essential and often makes me feel, counterintuitively, more energized. My second year of residency, I also became much more involved in my union and that's been great in so many ways - it has helped me feel like I have some more agency, and it's also been a really nice community to be a part of.

MIAAP: What advice would you give to medical students considering pediatric neurology?

HM: Try and get exposure to children with neurological issues in whatever way you can! Opportunities probably look a little different in every context, and you might have to get a little creative! (She gave the example of rotating through Developmental and Behavioral Pediatrics if you don’t have a big Child Neurology Department).

Child Neurology Society (CNS) has great learning resources for all levels of learners. Continuum (a journal from the American Academy of Neurology) also has great articles and overviews of every topic imaginable, and they have an excellent podcast too.

For anyone considering a career in Pediatrics, I would recommend getting involved with advocacy. There are so many great ways to get involved through professional organizations (for example AAP, AMSA, and AMA) on both local and national levels. Pediatrics is really a specialty that centers on advocacy, so getting your feet wet in med school can help you hone those essential skills. It's also, of course, so easy to lose sight in medical training of what this career is about and why you decided to go into it in the first place. Being able to reflect on how much power your voice has as a member of the medical community and see your efforts making a difference can be incredibly meaningful. Trust me on this one - advocacy is what will keep you going during the very long years of training!

MIAAP: If you had to watch one kids’ TV show on repeat during a 24-hour call, which one would you pick?

HM: Oh what a good question! To be honest I haven't watched too many kids TV shows, but I will say I am a little obsessed with Ms. Rachel. It's not a TV show, but I could also 100% watch Coco all day long.

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