CEHL:

A Family's Experience with Psychosocial Pediatrics

About 10 years ago my husband and I switched health care plans, which necessitated a switch in pediatricians. Our son was about 9 at the time and our daughter, 5. A colleague referred me to Dr. King.

I'd never met any doctor like him. Our previous pediatrician offered good care but was all business. If you'd call the office, you'd get an answering machine; if you had an appointment, the wait could be an hour. Bedside manner in the office could be questionable; once, when my infant son was being immunized, the nurse practitioner screamed at me because I got teary-eyed when he started crying. "Stop it Mommy," she said, accusingly. "Would you rather he got sick?"

Dr. King, by comparison, seemed so ... retro, a throwback to the days of black bags and head mirrors. He answered his own phone. ("It's easier that way," he told me.) He made follow-up calls. He never seemed to rush. He spoke quietly and slowly and always made eye contact with me and with my kids, sort of like a pediatric Mr. Rogers. (He even wore a cardigan.) And he asked so many questions, and not just about my kids' immunization histories or whether they'd had chicken pox. He wanted to know about their personalities, about how they slept and what made them anxious and whether they had nightmares or tantrums or behavior problems. He wanted to meet my husband, too, and arranged a Saturday morning meeting for the three of us, interviewing us in detail about our own family histories.

I have to say I was skeptical. "This is weird," I remember thinking during that meeting. Probably sensing my discomfort, Dr. King explained that he was interested in kids' emotional health, not just their physical well-being, and that it made sense to take the time to get to know families up front than to wait for a problem to develop and try to analyze it retrospectively.

"He's definitely out of the ordinary," my husband -- a physician himself -- concluded.

But over the years, I came to see that Dr. King was on to something important, that what was weird was not his intense and very personal approach to patient care but my own feeling that this kind of care was intrusive, my expectation that in an HMO universe, health care -- even for my own children ! -- had to be efficient and impersonal.

On the other hand, I've marvelled at how much stamina and energy this kind of approach to medicine would seem to demand, particularly in the context of a health care system that not only doesn't encourage it, but seems to actively discourage it, by overwhelming physicians with red tape and paperwork when their time could be better spent with patients. I've often wondered about why managed care systems, with their focus on the bottom line, haven't caught on to the obvious. If doctors got to know their patients -- and their patients' families -- better, they could pick up problems earlier, and save the system money down the line.

Over the years, Dr. King has heard from me a lot -- always answering his own phone, of course -- and I'm only one of the innumerable mothers he has to deal with. He's handled my kids' broken ankles and head lice, allergies and school anxieties. He's dealt with their fevers and phobias, chest pains and mystery aches. Every year, he cheerfully tends to their tedious camp medical forms; he never seems annoyed by the minutiae of running a busy practice.

I've also marvelled at how my oh-so-cool teenagers have responded to his intensity and care. I would have thought that they'd be put off by it; instead, they appreciate it and respect it. When my daughter was 12 and growing self-conscious, she told me, reluctantly, that she felt she ought to have a female physician now, but she was worried it would hurt Dr. King's feelings. (He took the news in stride, cheerfully making a recommendation and wishing her well.) My son, who grew into a typical high-energy, risk-taking, drum-playing teenager, continued to urge me to "call Dr. King" whenever some ailment, large or small, was troubling him.

Still, as he went through high school, I figured the time would come when he'd announce he was too old for a pediatrician. (I thought any kid who's taller than his doctor and drives to his own appointments was definitely due for it.) But he never did. "Why would I want to see someone else?" he snapped at me when I suggested a new doctor a few months ago.

Finally, this summer when he was turning 19 and had just completed his freshman year in college, I called Dr. King to make an appointment for his annual physical. "I'm flattered that he wants to see me," Dr. King said, "but out of fairness to him, I think he needs an internist now."

Now we're in trouble, I thought, and started calling internists. Of course, I reached their answering machines.

Linda Matchan

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Support

I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.


- Dr. Howard King, M.D.