Linda Thompson, MD and John Tobin, MD are retiring this summer after nearly 40 years as pediatricians at Hennepin County Medical Center (HCMC) where they’ve cared for underserved children and taught physicians who care for them. They have trained more physicians and medical professionals in primary care pediatrics than perhaps anyone else in Minnesota through their pediatric continuity clinics, everyday instruction to medical students and residents rotating through HCMC, and continuing education presentations.
What advice would you give to a young pediatrician?
Tobin: The costs are substantial, but the rewards considerable. You may be greeted with unabashed enthusiasm by a child, then criticized for being late or intrusive by the parents of another. Educational costs may be the same as those of colleagues going into more highly paid specialties, but the remuneration will not compare to theirs. You may make a difference in the life of the next Mozart or Einstein!
Thompson: Be prepared for hard work, long hours and a fair amount of worrying; this is the necessary price we pay for a life of fulfillment and enjoyment seeing kids grow and develop. Always listen to parents as carefully and empathetically as you can, bearing in mind that children sometimes hold the truth more so than their parents. Learning how to talk directly to children at a very young age is also important in order to provide optimal care. Read as much as time allows.
What are the biggest changes you have seen occur in your career affecting pediatric care and the health of children?
Tobin: Unquestionably, the continued development newer and more effective vaccines. Also, the Electronic Medical Record. There is now a premium placed on uniformity instead of molding the content of a visit to meet the needs of the child and family. Accompanying this is more and more requirement for measurable tasks with undocumented benefits.
Thompson: New vaccines and the virtual elimination of vaccine-preventable diseases; the disappearance of Reyes syndrome after the link with aspirin was shown; improvements in imaging techniques; advances in neonatal and pediatric intensive care; introduction of surfactant to prevent hyaline membrane disease; the explosion in medical genetics; and the increase in the proportion of women in medicine.
What are the biggest obstacles/challenges you foresee for pediatric care and children’s health in the future?
Tobin: Money. In this country we give lip service to the idea that children are important, but do not act on that principle. Witness the disparity between health care dollars spent on the end of life (much of it futile) and on the first years of life. Whether we speak of immunizations, nutrition, education, or drug development, children in the U.S. get short shrift.
Furthermore, private insurers have little incentive to provide more support, as they almost certainly will not be paying for the consequences of, say, obesity, for an individual child as an obese adult in the decades to come.
Thompson: Children’s mental health services need to improve; incentives for more people to train in child psychiatry and behavioral pediatrics and more collaborative efforts with schools, including preschools and day care centers, might help in this effort.
Racial disparities in health care access also need to be addressed. The quality of social services and the educational system are huge factors in determining children’s health. We as pediatricians need to partner with other professionals and not assume that we can solve all the problems facing children and families on our own.
What are highlights of your pediatric career? Your legacy?
Tobin: Time after time, the highlight of the week is my Continuity Clinic with University of Minnesota Pediatric residents. They have taught me far more than I have them! The fact that these residents and others have told me that they have learned the value of truly listening to what the parents have to say would unquestionably be my legacy.
Thompson: For 20 years I was the primary care doctor for NICU graduates at HCMC, often following them into their teenage years. I attended many funerals during those years and witnessed much sadness as well as some triumphs. During the past 27 years I have also worked with child abuse cases and have seen the development of this field culminating in the approval of child abuse pediatrics as a subspecialty by the ABP in 2009. Educating young pediatricians in Continuity Clinic has also been a great joy and has led to many long-term friendships for which I feel very privileged.