As a 4th year med/peds resident, I have seen my share of patients in my continuity clinic struggling with illnesses that could be treated or prevented by lifestyle change alone. In particular, I have had my share of pediatric patients struggling with obesity. This can be a frustrating problem to troubleshoot with families, as it often feels like you are fighting the battle all by yourself as the child’s pediatrician. Way too often, I feel that no matter what advice I give, and no matter what resources I may offer, lifestyle changes will not be made in order to get the child’s weight and health back on the right track. This can be incredibly frustrating as a pediatric provider, because there are so many preventable diseases and complications that result from childhood obesity that I see in my adult population on a daily basis, and I know that these unfortunate outcomes can be avoided if the appropriate steps are taken. My head is often full of the same questions– Why don’t they listen to me? Why don’t they follow through with these recommendations? Why is it so hard for them to encourage their child to play outside, especially in such beautiful weather? Why don’t they just stop feeding them terrible foods and sugary drinks they seem to be having on a daily basis? Don’t you want them to get on the right track to improve their health? Why did they miss the appointment with the dietician? How can I help if they don’t seem to want to help themselves? In a way, it feels like they are failing me as their provider who is just trying to do what is best for them.
As a part of the community pediatrics rotation, we were asked to do a “windshield survey” which consisted of personally exploring the neighborhood surrounding our clinic. I was aware that the area had its difficulties just from my drives to and from clinic and from discussions with some of my patients, but completing this assignment was truly an eye-opening experience for me. I was asked to not only observe the area, but to figure out how I would manage on a daily basis. This included figuring out where I would eat, what kind of food my family would have access to, if I would feel safe outdoors, what the conditions of the sidewalks were, among many other questions. On first glance, I saw what I expected to see— a poorer neighborhood with older, unkempt homes. On further investigation, it became clear to me just how difficult it could be to maintain good health while residing in this area.
Imagine you and your child are struggling with obesity. You go for your child’s well child check, and the pediatrician tells you that your child’s health is in danger. You are instructed to avoid frozen meals, junk food and fast food, eat more fresh produce, allow for minimal screen time and encourage outdoor play and exercise. Sounds simple enough to some, but what if the only “supermarkets” within a 3-mile radius are a Family Dollar and a SafeWay, which have abundant salty snacks, candy and frozen meals, but minimal to no fresh produce? What if you do not own a car, or share a car with multiple other family members, and the majority of the time the only way for you to get to the store or to appointments is by foot? What if your budget for food is minimal, and even if there is fresh produce available, it is more cost effective to spend on frozen foods? What if you felt unsure of your child’s safety outdoors, even in broad daylight? What if you have other young children at home, so would be unable to leave and be a chaperone for your child to play outside and get some exercise? These are just a few of the numerous struggles that I know many of my patients and families deal with, but most of the time will not bring to my attention.
After this assignment, I realized that in while in clinic with patients, as my mind tends to wander and ask so many seemingly fair questions, so do theirs. Such concerns are not often brought to my attention, which could be due to embarrassment or fear of judgment. As the provider, I need to dig deeper and make it my responsibility to attempt to identify these social concerns that are impacting the health of my patients so that I can provide the appropriate information and resources that may actually be useful to them. Maybe instead of asking myself all of those other questions, I should be asking myself “what obstacles could be preventing them from reaching the goal, and what can I do to help?” If I am unsuccessful in recognizing the potential limitations in the lives my patients and continue to offer the same generic advice and plan to every single one of them, then evidently my patients are not failing me or even themselves- I’m the one failing them.