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What’s in a Doctor’s
Bag?
Maria O. Stanislaw, DO
Marshfield Clinic, PGY2
Marshfield, WI
Advocacy
 Advocacy
is the pursuit of influencing
outcomes that directly affect people’s
current lives.
 Marshfield Clinic’s Pediatrics Residency
program requires an advocacy or research
project before graduation.
 My project is called What’s in a Doctor’s
Bag?
The Summer
Day by Mary
Oliver
“Tell me, what is it
you plan to do with
your one wild and
precious life?”
Walk a Mile in their Shoes







Threatening
Uncomfortable
Restricted movement
Separated from parents
Viewed as a punishment
Undressing in-front of strangers
Memories of shots, gagging, forcibly
restrained…

Routine visits have potential to produce
stress
1990. Goldberg, L.; Gaynard, L.; and Wolfer, J. Helping Children Cope with health-care procedures.
Contemporary Pediatrics, March. 141-160.
Poof!!! Be Gone


Prelogical thinking prevails between 2 and 6 yo.
Children use their immediate spatial and
temporal cues to determine their reality
 Doctor visits can be viewed as a punishment
implemented by a villain (the doctor)
 By introducing children to medicine in a nonthreatening manner, we can remove some of
their misconceived perceptions.

2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215.
What are the goals?
Don’t Worry, Be Happy

Take the unknown out of the well
child visits

41 mothers with toddlers routine
immunizations
 If children were informed before
immunizations, the shots were less
distressing
 They had the chance of using selforiented strategies rather than
avoidant coping strategies.
2008. Favez, N. and Reichert, M. Toddler’ Adjustment to the Stress of Immunizations.
Early Child Development v178 n1 p49-64.
Practice Makes Perfect
 Make
believe medical
consultation for preschoolers
reduces anxiety when visiting
doctors.
2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215.
Proactive approach to health
 Decrease
barriers
to healthcare
 Invested interest
in their own health
 Up-to-date on
immunizations
 Well child visits
Early career choices
 Studies
show that
career aspiration
can begin as early
as elementary
school
 It’s never to early
to spark an
interest in a
medical career
2000. Jessee, Peggy; Wilson, Heidi. Childhood ducation. Vol 76, issue 4,
p215.
Have fun!
 Play
is a medium to
learn about the
world- Piaget,
Erickson
 Switch form passive
observer to active
participant
 Conquer fears
1988. Oremland, E. Mastering development and
critical experiences through play and other
expressive behaviors in childhood. Children’s
Health Care, 16 (3), p150-156.
My Plan

Target population:









Head Start to 3th grade
Rural Wisconsin children
20 minute presentation covering the basics
Split into small groups
Typical medical equipment in a well child visit
Name, function
Identify body parts
Hands-on approach
Children are sent home with an encouraging
flyer for parents to read and discuss
Overall Goals
 Encourage,
guide, ask questions, answer
questions, respond to concerns and have
some fun…
Outcomes
 No
formal measure
 Plenty of smiles and hugs
 Positive feedback from parents
 Reminder about why I’m in primary care
Long-term Plans
1
1/2 years in Marshfield
 Continue the program until my graduation
and then set up a similar program at my
future practice site
 Future plans: To include surrounding small
towns
Perception is Everything

A study in rural Ireland focused on how the
process of health visits in homes and schools
changed parents’ perceptions medical care
 Parental perceptions of being supported were
exemplified by:






Increased confidence in infant care
Reduced anxiety
Increases in knowledge
A sense of personal competence in parenting
practices
Reduced isolation
McIntosh, Jean. The process of health visiting and its contribution to parental support in the
starting well demonstration project. Health and Social Care in the Community 15(1), 77-85.
 “The
specific leadership of pediatricians is
often key in overcoming political and
cultural barriers.”
Grason, Holly. Pediatrician led community child health initiatives. Pediatrics vol 103 No. 6. June 1999.
How can you repeat this project?
 What
do you advocate for?
 Where is your passion?
 Does your residency have a similar project
requirement?
 What simple thing can you do TODAY that
will have positive outcome on
TOMORROW?
“What do you plan to do with your one
wild and precious life?”
 Thank
you for your time. Any questions?
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