I have had a long day when one counts the hours, but I feel happy. I have had multiple meetings on a broad range of topics and challenges, but I feel rested. I have a cold, but it seems insignificant. Why? Because today I took care of children. I made a difference in their lives and reassured their very worried parents that the headaches were not caused by a brain tumor, and that the mild tics were not seizures or epilepsy. Tonight, I am more upbeat about everything and I owe that to two beautiful ten year-old children I served, as their doctor. Our department and children’s hospital serves hundreds of children every day, and as a nation we are trying to figure out how to serve millions with health care. I am convinced that our greatest contribution as pediatricians is serving children one at a time!

Respectfully submitted,
Dr. Bernie Maria

All of us who are parents know how our children are a source of great pleasure and great stress. This week, one of our pediatric residents was trying to cope with a sick child of his own. I noticed that, as his child’s health improved, the resident regained his color and normal charming, outgoing personality. This weekend, our family’s focus was on how to help our 15 year-old son who has a learning disorder work more diligently with my wife who is digitally homeschooling him…very stressful! These experiences and observations have taught me two things: first, pediatricians shouldn’t play doctors with their own children and teens; and second, they can’t.

One thing is certain: that the children, families, and colleagues we serve everyday in our work are often unaware of how we have to compartmentalize our personal business to be effective in our work. The challenge for us all is to make use of our personal challenges to better the lives of the children we passionately serve. Even when family comes first as parents, there is fuel for our work as pediatricians.

Respectfully submitted,
Dr. Bernie Maria

In the national news today, it was announced that teens were having more children. This fact is a major threat because so many teens are putting their new babies into a perpetual cycle of poverty and lack of education. Their children are less likely to be healthy. Why aren’t folks alarmed? I am not an expert on the subject, but I would be surprised if there aren’t some proven educational interventions. I wonder why our society is so quiet about this. What are the ethics of paying a teen to not have a baby? or a second? Would that not improve overall child wellbeing?

Respectfully submitted,
Dr. Bernie Maria

Next Wednesday (February 3, 2010), we launch exciting new clinical programs, First Visit and PIRATE. One major problem for pediatricians across the country is ready access to subspecialists for non-urgent problems (referrals). There are many health problems in children that require the expertise of endocrinologists, cardiologists, dermatology, developmental experts, child neurologists, child psychiatry, and so on. The demand for this expertise is so high nationally and regionally, that families often have to wait many months to be seen. As a father, it has always bothered me that others would have to wait much longer to see a doctor than I could ever tolerate for my own child. It’s just not right!

There are a number of reasons for this challenge but the root cause is a shortage of pediatricians and pediatric subspecialists as recently reported by the National Association of Children’s Hospitals and the New York Times. Sixteen states lack at least one physician in one of 13 sub-specialties for pediatric medicine. So the mid- to long-term solution is to train more pediatricians and pediatric specialists, which we are doing, but this will take years to have an impact. In the meantime, we need to work smarter with the expertise we have. We are therefore implementing a new model of care and service for local referring pediatricians. We are piloting the program in child neurology with both Drs. Carroll and me as partners. We will see a new referral for child neurology within 7 weekdays (First Visit) because highly-qualified nurse practitioners Katy Slagle and Pete Way will assist with follow-up care under our supervision. As long as families arrive 15 minutes ahead of the scheduled appointment, First Visit patients will be in the clinic room at the appointment time, exactly (PIRATE).

I am very excited about this model of care because it provides outstanding and timely service to children, families, and referring pediatricians. I am grateful that Hospital Interim President and CEO, Sandi McVicker, is investing in this new model of care that I hope to spread across our 13 subspecialty divisions in the department as well as other Children’s Medical Center programs.

Respectfully submitted,
Dr. Bernie Maria

A study that I conducted a couple of years ago on what pediatricians (and other physicians) value showed that all four working generations (silent, boomer, X, and Y) value autonomy above service and scholarship. Yet, medicine is more team-based than ever, and academic departments like ours need faculty to serve children and advance the field of pediatrics with teamwork. I believe that practicing individual goal-setting, participation, and feedback (Management by Objectives) will help us reconcile who we are with what is needed to take the department to the next level of excellence.

Respectfully submitted,
Dr. Bernie Maria

Sir William Osler is regarded as a founding father of American medicine. I can remember as a student and resident visiting his library at McGill University in Montreal, and looking up in awe at the Johns Hopkins Hospital Dome where he slept as the founding chair of the department of medicine. Osler’s life principles are the foundation for my daily work. Today, we had a grand rounds presentation by Dr. Bahig Shehata from Emory University about pathology and its origins since Rudolph Virchow. Interestingly, it was after meeting Professor Virchow that Osler resolved to become a great clinician and teacher.

So what would Osler say about our current departmental focus on individual goal-setting?
As Charles S. Bryan says in his book, “Osler, Inspirations from a Great Physician,” Osler was an obsessed goal-setter who viewed life predominantly as an unbroken series of projects. As we assemble tomorrow, January 23rd, to learn how we can set effective individual, professional goals to better serve children, let’s not forget what Osler said many decades ago and would probably say to us today: “When schemes are laid in advance, it is surprising how often the circumstances fit in with them.”

Respectfully submitted,
Dr. Bernie Maria

Over the last 6 months, our departmental focus has been on department-wide and divisional goals. In Jim Collins’ Good to Great terms, we defined our Hedgehog Concept: we affirmed our passion for education, our national leadership in prevention research, and that our children’s hospital is our economic engine. We reached a consensus on our immediate departmental goals: achieving an exceptional residency Match, launching the Child Health Discovery Institute, implementing FIRSTS, and enhancing individual goal setting practices.

To motivate and reward high performance, we must adopt sound evidence-based management practices and this week, our attention will be on individual goal setting. On Saturday January 23rd, University of Florida Management Professor Henry Tosi will educate us about the science and art of setting focused goals.

As department chair, I am highly committed to this process for the following reasons: (1) each faculty member in our department should have a clear concept of how their goals contribute to departmental success; (2)participating in goal setting will increase acceptance and commitment, thus leading to enhanced performance; (3) division chiefs and I will have more specific information about the relative contributions of each faculty member; and (4) the annual process of evaluating relative contributions will be a key factor in determining the level of departmental support for individual faculty and their respective divisions.

Respectfully submitted,
Dr. Bernie Maria

Today, there are over 100 children sick enough to need our help in the children’s hospital. Not too far south of us are literally thousands of suffering and fearful Haitian children and families. In overwhelming human crises like the aftermath of this earthquake, we can make a difference by donating money to worthy organizations, such as the Red Cross, by reaching out to colleagues with family ties to the region, and by pouring ourselves into caring for our own hospitalized children and the thousands of clinic patients that look to us for normalization. Our hearts as pediatricians bleed for Haitian children while our brains can focus on the job at hand at home. Poverty is a root cause to individual and societal catastrophe, yet each one of us can make an enormous difference one patient at a time. We pray for our brothers and sisters to the south during the massive aid efforts.

Respectfully submitted,
Dr. Bernie Maria