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My First Steps Experience


In recent years the medical community has made great strides in recognizing the importance of treating our population of patients as a whole, not just individuals. I believe on our community rotation during residency there is a lot of emphasis on this type of work and viewing our practice as more than treating one individual at a time. With that said, one experience in particular instead placed emphasis on the points in time when as a physician you should look at the individual for who they are and tailor your treatment to them and them only. This experience was my First Steps evaluation, which taught me more in 45 minutes than many of my rotations during medical school had taught me during an entire week.
First Steps, for those who do not know, is an organization which specializes in early intervention for those children with developmental delays ranging from motor to communication and socialization. After performing the initial evaluation of the child at their home, resources are provided specifically for that family in order to help the child reach their full potential in the areas in which they are struggling. My experience in particular involved a toddler who was struggling with verbal communication, while excelling in gross and fine motor development. Right when we walked in I was so impressed with how the evaluators interacted not only with the patient, but also with the mother and even with each other. They were a well-oiled team, who was able to gain exactly the right amount of information needed to assess the patient and what resources would need to be provided.
I was amazed by all of the ways that questions were asked to mom to gain the appropriate information, by the ways that they were playing games with the child to assess his abilities truly at his core, and even specifically, the way the two evaluators worked with one another to ensure smooth transitions in conversation. After determining that the patient was in fact a visual learner as opposed to one whom relies on verbal communication, the evaluator played a new game. The patient had one of those games in which you match the shape with the appropriately shaped hole in order to put the blocks in the bucket. He LOVED the purple circle and how beautifully it fit into the circular hole. He loved the circular hole so much, that he felt that every other shaped block should also fit as beautifully. However, as one can assume, and as cliché as it sounds, you really cannot fit a square peg through a round hole. Frustrated repeatedly by this the patient would just remove the top of the box and place all 4 of the other shapes in by hand, which I actually found brilliant in its own right. I mean, why would you match shapes when you could just easily put all of the blocks in at one time, but I digress.
The evaluator, realizing that the patient was a visual learner, worked with him by covering all of the other holes (and yes, by specifically covering the amazing circle hole) in order to show him that the square block had its own square hole, as well as, the star, plus sign, triangle, and heart. Each time he would get one right all of us would erupt into praise and clapping, which let me tell you, clearly made his day with the huge smile that broke out on his face. We did this repeatedly for all of the shapes for 10 minutes, at which point he was able to do all of the shapes by himself. For a child who would only concentrate on a circle for months to be able to recognize all of the shapes in 10 minutes was truly inspiring to see and it was all because we changed our interactions with him to accommodate his strengths in learning.
After we were done with that activity we went back to talking with mom and allowing free play. But wouldn’t you know that in the midst of us talking to mom he went and grabbed the block game, drug it to a corner of the room, and continued placing all of the blocks into the correct holes. This moment in particular was one that touched my soul. While looking at the big picture is an important part of medicine, remembering that everyone is an individual, I believe, is equally important. Some people are verbal learners and others visual learners. We are all different and unique, and embracing those differences while incorporating them into our practice as pediatricians can lead to beautiful outcomes for children. No one child is the same, but isn’t that the wonderful and engaging part of being a pediatrician and working with children after all?

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.

Carley Niehaus