The pillars of pediatrics

July 2007

Some days during an office visit, or when I write my column about some people, I feel like the new television show’s heroine, “Ugly Betty.”

This television sitcom features a somewhat average adolescent girl who is serendipitously the glue both morally and officially in a high-powered, chaotic fashion office. She is always sticking her nose in other people’s business and often makes a humorous mess of the situation. Through television magic, she often seems to pull it together within the hour and save the day. But sometimes she fails, as well; I empathize. Her role is sort of like the Drew Carey of the fashion scene.

I have had some experiences analogous to “Ugly Betty” recently. For instance, I was concluding an office visit with one of my shorter young teenage patients, who became mortified when I told her that she was unlikely to grow any further after menstruating for two years. I cajoled her, trying to cheer her up by saying, “Look dear, you can be petite, cute and smart like you are now, or you could have been big, dumb and ugly like me.”

Her rapid-fire response: “You’re not so dumb, Dr. Block. After all, you are a doctor.”

I retorted, “But what about the ‘big and ugly’ part?”

She responded, “No hope there.”

I looked over at her mother and said, “Brutally honest, isn’t she?” and we both chuckled.

It is my role in life to be the whipping boy and verbal punching bag for teenagers, both in the office and in my own household of four daughters — perhaps, karma’s payback for all my prior transgressions. Hey, if it defuses their situation, and they are able to smile again and realize that it could always be worse (thanks a lot!), I am thrilled with the aspersions.

Thus, the Ugly Stanley title must stick.

Pillars of pediatrics

Since most of our readers are general pediatricians, I thought that I might bring up the invaluable role that some incredible people play in the world of pediatrics. These folks are often taken for granted by us “local medical doctors” (or LMDs).

These often unsung heroes are the pillars of the pediatric world; they are the chairs of the department of pediatrics. Like pillars of any building, they often steadfastly stand in the background as the stabilizing force, holding together the past, present and future of the world of pediatrics.

We too often take them for granted, like pillars in a building, when we should actually ponder the magnitude of the critical nature of their work. In my travels and AAP committee memberships, I have had the distinct honor of meeting my share of these gifted and charismatic pediatricians during the last two decades. I want to discuss with you some of my observations.

Recently I received a solicitation from the University of Kentucky Children’s Hospital foundation to donate. The brochure included a photo of several children and the hospital chair, Tim Bricker, MD. As an alumnus, because of the cause and having spent some time with the affable Bricker, there is no way one could ever refuse that winning combination. Another role of the chairs we often overlook is that of chief fundraiser, bottle-washer and front man/woman.

Personal encounters

First, whenever I converse with or listen to these brilliant minds, I again realize I really am the Ugly Betty in the room. If you are lucky enough to see them interact or discuss issues with their cohorts or subordinates, one gets a feel for the extraordinary nature of these pillars.

Next, one must acknowledge their backgrounds. To become a chair of the department, these pillars must be extremely accomplished in their field of expertise. They must further command a substantial amount of knowledge about most of the subspecialty fields of pediatrics, sort of like the Renaissance man/woman of pediatrics. And interestingly, they must be able to “herd cats,” as follows.

As Jerry Rabolais (current Louisville, Ky.) has explained to me, a chair must be able to grasp the sweeping view and interdependence of their hospital and its crew: their faculty and the entire staff, along with the community needs and the economic interconnectedness of each. They must also help to run a multimillion-dollar enterprise known as a children’s hospital. The chairs must meld the brilliant minds and fierce independence of their intellectually oriented faculty with the business need of a hospital to produce income and serve all children in their community — paying or not. They must also deal with Medicaid payment rates on a mega scale while still running a teaching hospital.

Furthermore, what becomes even more remarkable about these pillars is to learn about some of the nuances of their additional roles in pediatrics. Despite their busy schedules, most continue to work tirelessly in teaching (even in retirement,) or in research or AAP/subspecialty areas.

Not only are they skilled listeners, but when any take the podium at a pediatric meeting, their compelling persona shows. I have personally observed several of them lead a group of pediatricians commandingly and respectfully and guide the meeting along punctually, yet all the while gathering opinions from each person in the room. Then they each can summarize the day’s events succinctly and accurately, weaving this into the needs of the day’s agenda. If artful leadership qualities are acquired or inherited, I do not know. However, few of us possess them.

Each of them also shows that they care about and carefully reflect upon the thoughts of LMDs, such as Ugly Stanley and other community pediatricians, whenever engaged in discussions. That is remarkable when you consider their lofty positions and fund of knowledge.

None of them dress ostentatiously (apologies to Ugly Betty’s fashion police), nor, of the ones I know, do they drive glitzy cars or wear excessive jewelry (sorry guys). These are not flashy people externally (none wear “Spiderman” ties like me.) They lead by listening and by terse eloquent articulation.

The new and the old

Now, among the chairs I have come to know, we have the seasoned group and the new kids on the block, so to speak.

Within the seasoned group, I have personally observed how Larry Cook (past Louisville), Jimmy Simon (Wake Forest, N.C.; retired) and Arnold Strauss (formerly of Vanderbilt, now at Cincinnati) personally embrace the LMDs and their concerns and input for their children’s hospitals. Among the “new kids,” I have witnessed Rabolais and Bricker display the same traits.

I have even witnessed a most amazing phenomenon while visiting with three of the seasoned chairs. Simon, Strauss and Russell Chesney (Memphis, Tenn.) seem to know everyone at their respective hospitals. From all of the residents and faculty to the social workers and nurses and down the list to the maintenance folks, they know their names and warmly acknowledge all who cross their visual path while walking the halls of their hospitals. Heck, some days I can hardly remember the name of the guy in the gorilla suit in front of my mirror. One can understand why each of these individuals is venerated at their institutions.

Among the ones I have heard lecture before, most are also blessed with incredible and quite articulate speaking skills. For example, a general pediatrician can become immersed and mesmerized while listening to a Jimmy Simon presenting fascinating photo cases; to a Russell Chesney discussing the analogy of Occam’s Razor with pediatric care; to a Joe St. Geme (current Duke), Ellen Wald (Madison, Wis.) or Meg Fisher (Monmouth, N.J.) showing the latest infectious disease study or to a Sam Katz (past Duke) arguing for a better universal vaccine policy or for a Red Book committee meeting.

Among the novice ones I have seen lead large or small AAP meetings, Wald, Fisher and St. Geme move a meeting along effortlessly while engendering input from members.

Each of these folks adeptly handles even more cantankerous members (Ugly Stanley, for one) without leaving hard feelings.

Remember, the chairs must also frequently handle some of the more distasteful and challenging aspects of heading a program: the selection, disciplinary and the (rare) firing process for faculty and residents. Talk about heartburn/insomnia city! Some of the dilemmas and career-altering decisions they must adjudicate must be mind-boggling. Yet they each gracefully accept their critical role in this arena, as well. They know they do it for the greater good of the pediatric community.

So, please remember — at least annually — to thank your local pediatric chair (a holiday card, for instance) for all they do for us, the residents, the faculty and the community. These are some amazing and selfless folks.

For more information:

• Stan L. Block, MD, has a pediatric practice in Bardstown, Ky., and is a member of the Infectious Diseases in Children editorial board.