CHAT rooms revisited

My editor alerted me to a recent article in Pediatrics“Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)” — and asked if I might provide a bit of commentary. I obliged with a few revised thoughts on developmental surveillance and screening in the pediatric patient. more»

For those readers who aren’t familiar with the tool, the M-CHAT is a screening instrument designed to identify toddlers at risk for ASD — that’s Autistic Spectrum Disorder, not Atrial Septal Defect, which is a different problem entirely, diagnosed using the grey matter between the ear pieces of a stethoscope in lieu of a parental questionnaire.

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The Art of Medicine: Selling yourself in primary care

As clinicians in primary care, much of our success depends directly upon how we relate to the patient. In most instances these relationships are built slowly over time. It is much more difficult to garner complete trust at the initial clinical encounter — difficult, but not impossible. more»

Interested readers can now access my latest Art of Medicine column — Selling yourself in primary care — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

My last day

On this, my last day,
After 20 years in this practice
I saw 31 patients,
Administered 19 immunizations,
Counseled 4 distraught parents,
Reassured 17 mothers,
Praised 3 new fathers,
Called in 8 prescriptions,
Reviewed 14 laboratory studies,
Signed 9 daycare forms
And 6 school exam forms,
Completed 5 authorizations for medication,
Ran 4 rapid group A strep tests
(3 of which were positive),
Explained 25 times why I was leaving,
Ate a piece of homemade carrot cake,
Emptied out the contents of my desk,
Watered the dying peace plant,
Hauled my files, books, notepads,
Cards and gifts (2 bow ties)
Out to my car,
Slammed the tailgate shut,
Climbed into the driver’s seat,
Adjusted the belt and harness,
Inserted the key,
Hit the ignition switch,
Slipped the car in gear
And rolled across the parking lot,
Forgiving a betrayal
Without looking back.

15 November 2013

2013©Brian T. Maurer

A Kodak moment

I step into the exam room carrying a small tray of supplies: one unit-dose syringe, a cotton ball moistened with alcohol resting on a 2 X 2 square of gauze, a Band-Aid dot. On the exam table the patient, a 5-year-old girl, squirms in her mother’s lap.

“She’s here for her flu shot?” I ask, merely to verify the inevitable.

“Yup,” her mother replies. “And it’s not going to be easy.”

“Most kids don’t like shots,” I mutter in a quiet voice as I slide the tray onto the counter top. “Here, let me show you how to hold her.”

I instruct the mother to turn the child to the side, sitting her on the mother’s thigh with the child’s legs draped between her own. “She can give you a big hug under your arm, around the back. Now hold her forearm with your one hand and hug her tight with the other.”

The mother complies with my instructions. As I pick up the syringe and cotton ball, like a frightened puppy the child lets out a yelp and begins to writhe in her mother’s lap. “Hold her tight,” I reiterate, as I slide my free hand beneath the girl’s upper arm to steady her shoulder.

I dislodge the needle cap with my teeth and stand poised, ready to slip the hypodermic into the deltoid muscle. Suddenly the child breaks free, kicks and screams, turns and twists, thrusts her head back and forth. Blindly, the mother sweeps her arms through the air in an effort to recapture the child. In the fray she falls to the side, taking the child and me with her down to the padded surface of the exam table.

There we lie, like the Marines in Iwo Jima, a frozen fleshly sculpture of arms and legs, intimately conjoined in intricate knots of skin, bone and muscle.

Eyeglasses cocked awry, the mother looks up at me, hugging her daughter for dear life, while I rest along the contour of her curves. The image burns into my mind. Without thinking, I say, “You know, if this were a photograph, it would undoubtedly appear as a black-and-white full-page spread in Life magazine.”

Quickly, I administer the shot. The mother releases the little girl and we all sit up. The child is sobbing, and so is the mother, as tears squeezed from her laughing eyes cascade down her cheeks.

“Thank God you’ve haven’t got a photographer in house,” the mother wheezes, as she wipes her face with the back of her hand.

Another memorable Kodak moment in primary pediatric practice to treasure.

This piece was originally published in the Spring 2013 edition of ConnAPA News.

The problem with primary care

Where does our job satisfaction come from? Money has been put forth as a likely determinant.

Over the course of my clinical career I’ve felt most satisfied when I’ve been able to focus on the needs of the patients entrusted to my care.

Money is a great motivator, but in my book only compassion carries the day. more»