By Dwain Hebda // Photography by Jeremy Smith
In 35 years of pediatric medicine, Dr. Alan Lucas of Arkansas Pediatrics of Conway has had the pleasure to collaborate and comingle with many fellow physicians, be they long-timers like himself or green newcomers right out of residency.
But in recent years, he’s found he’s often partnered with a peer he’s never met, can’t consult with and frequently has had to contradict.
“Dr. Google, as we call it,” Lucas says with a laugh. “Medicine has definitely changed.”
In describing the most noticeable trend within his medical specialty, the changed dynamic of the patient-physician relationship is at or near the top of Lucas’ list. Parents today are, for better or worse, much more likely to come into an appointment having done some homework and formed an opinion on what may be the problem.
“We see more couples coming in for their visits with their children, or we see grandparents coming in, partially because the parents might be working,” Lucas says. “A lot of them, I say, have ideas or thoughts about what’s wrong with their child.
“[As a physician], you definitely have to adjust and adapt,” he adds. “We always say that probably 80 percent of our diagnosis is based upon the history we obtain from either the patient – if they’re old enough – or the family. Then it is correlated with physical findings. A lot of times, they will come in with opinions, and as soon as you hear the history you go, ‘No, that can’t be the case.’ Or they think their child is among the sickest children that you’ve ever seen and you say, ‘No, that’s also not the case.’”
Lucas is no curmudgeon when it comes to technology – far from it. Knowing the crowd he’s dealing with in 2019 is a far cry from that of 1989, he points to the appropriate use of technology as an essential aspect of his practice.
“It works both ways,” he says. “I’ve used the internet a lot for education. I may give them a diagnosis, and there are some strange diagnoses, where it helps if I write that down on a piece of paper and say, ‘Go Google this.’
“That way, they know why we arrived at this diagnosis, why we recommended the treatment that we did and, if it doesn’t seem to improve within this period of time, then this is the plan that we will follow up.”
Dr. Dawn Martin with All for Kids in Little Rock says the reliance many families place on online resources is a generational sign of the times.
“Especially with first-time parents and inexperience, they’re not as trusting as their parents,” she says. “They look to the internet, they look to blogs, they look to friends, they look to social media. I get a lot more questions concerning that first and then work to help them as to the right or recommended path to follow.
“It varies on the personality of the parent, obviously,” she adds. “I think with social media and the internet and quick access to multiple medical information sites – some being accurate, some not – that it creates more discussion with parents about alternate ways of doing things. Or, if something is not correct, then we have discussions about that and why that may not be beneficial.”
One conspicuous example of the problems that online information overload can cause is the lingering debate over the safety of vaccinations, which gained much of its steam through social media.
“I am a pro-vaccination individual. I think vaccinations are the greatest modern medical invention of our time,” Martin says. “They have been studied in depth, and if you look at the scientific research, you will see they are safe, and they are effective. We don’t make vaccines randomly; we make vaccines based on disease, illness, morbidity, mortality. We’ve seen the benefit of that with fewer measles cases. Polio is gone. Mumps is decreased.
“But while I think vaccines are important for the safety and health of your child, I have people who see me who do not vaccinate. I don’t agree with that, but I’m going to educate them, talk with them and try to understand where they’re coming from,” she adds. “Then we’re going to hopefully move together toward that trusting relationship where we come to the conclusion that this is the right thing for your child.”
Martin says other changes in the pediatrics field include the types of conditions she’s addressing – namely mental issues such as anxiety and depression – which in the past were considered outside of the pediatrician’s scope.
“When I was in residency, we didn’t really manage [many mental health issues] in the general clinic. We sent them to the specialist and the specialist managed it,” Martin says. “As I’ve been in private practice, specialists are limited and getting someone to see the specialist is difficult. I’ve had to be more of a provider than what I was used to doing.
“My clinic as a whole and I as an individual have had to do more special education, more continuing medical education. I’ve had to do more of my own post-graduate education so that I’m able to take care of these issues in the primary clinic.”
Other medical conditions in the pediatrician’s realm aren’t necessarily new but are more frequent and affecting children at much younger ages than in previous years.
“I see a lot more complications from obesity in children, even as young as 10 years old, who already have high blood pressure that needs to be treated,” says Dr. Janet Cantwell with Harvey Pediatrics in Rogers. “Also, the onset of Type 2 diabetes, which is adult onset diabetes, I’ve seen in a 10-year-old as well. So, there are a lot more adult-type problems in younger kids due to being overweight.”
Given this fact, it’s no surprise Cantwell lists an increasingly sedentary lifestyle as the number one health risk facing Arkansas’ children today.
“The lack of outdoor time and being outside, I think, has a huge effect on kids,” she says. “I don’t think our current society recognizes how important being outside is for sensory integration, confidence levels and decision-making. I’m just talking about going outside and climbing a tree. I consider that a health issue.
“Used to, 15 years ago, I’d ask a kid ‘What did you do over spring break?’ and ‘Oh, we went camping, and we did this and this.’ Now, it’s like, ‘I’m so bored. I just played on my tablet the whole time and played Fortnite.’ I think it’s a huge issue. I think that’s where a lot of our behavioral issues come from as well – the anxiety, depression, sleep disturbances.”
Despite popular belief, many families continue to utilize pediatricians’ services past their children’s early years, in some cases by quite a bit. Cantwell says in choosing a pediatrician, parents should shop around, as there are many practices from which to choose.
“Always ask what the policies are of the practice,” she says. “For example, ours has an immunization policy; if you don’t immunize your children, then you can’t come here. How are things managed after hours? What hospitals are they affiliated with? Do they do in-patient care?
“Do they offer separate sick and well-waiting rooms or a separate place for the newborns to come for their first visits?” she adds. “How are messages and phone calls handled during office hours? Do they have a phone nurse that is going to get back to them within the same day?”
One thing parents frequently overlook, Cantwell says, is the importance of being in step with a pediatrician’s personality and bedside manner, which is often as important as their technical skillset.
“One of the things I tell them is, if you end up coming and seeing me but then the next time you see another pediatrician and your personality syncs better with them, then that’s OK,” she says. “I’m not going to be upset if you decide that you don’t want to see me anymore, and you’d rather see one of my partners. That’s fine. I think that’s an important question to ask if there’s going to be a problem if you prefer one personality over another.”