Home | Word from the President: Lori DeFrance

Word from the President: Lori DeFrance

August 13, 2018


With humility and gratitude, I have transitioned into the role of MNAAP president. Dr. Kiragu, our past president, has been an outstanding role model for leadership as he has guided us through the past two years with unwavering dedication and focus. Thank you, Dr Kiragu!

I will take this opportunity to introduce myself. I have practiced general pediatrics for 29 years in Duluth. How lucky am I to see the expansive and stunning vista of Lake Superior every day as I drive down the hill to The Duluth Clinic. My husband is a pharmacist at a Federal Prison Camp. I have a daughter who is starting her second year of medical school and a son who is an electrical engineering student. We became empty nesters two years ago. Much to her delight, our French Bulldog, Rosie, has become the center of attention in our household.

In June, I attended the AAP District VI meeting in Itasca, Illinois. This is an opportunity to interact with the chapter leaders of other states and Canadian provinces in our District, and to hear an update on the American Academy of Pediatrics’ priorities, challenges and strategies for action and ongoing advocacy. Dr Kyle Yasuda, president-elect of the AAP, opened the session discussing these key areas of concern: detention of immigrant children, physician health and wellness, diversity and inclusion initiatives, NAS and the opioid crisis, and e-cigarettes.

I gathered some interesting take away information from the many sessions – I will highlight toxic stress and implicit bias here.

Toxic stress is at the epicenter of national discussions around separation of families at the border. A type of toxic stress that we observe in our daily practice is called Pediatric Medical Traumatic Stress (PMTS). This can frequently go unrecognized and untreated.

According to the National Child Traumatic Stress Network (NCTSN):

  • As many as 1 in 5 parents developed PTSD about 3-6 months after their child’s PICU admission.
  • Up to 80 percent of children and family members experience Post Traumatic Stress Symptoms (PTSS) following a life-threatening illness, injury or painful medical procedure.
  • Up to 20-30 percent of parents and 15-25 percent of children and siblings experience PTSS that impair daily functioning and may affect both treatment adherence and recovery.

This is integral to the recognition of ACEs, resilience and trauma-informed care. Dr James Duffee, a child and adolescent psychiatrist in Ohio who presented on trauma-informed care at the District meeting, highly recommended the book “Attending: Medicine, Mindfulness and Humanity” by Ronald Epstein, MD, that I have added to my reading list.

In an effort to minimize toxic stress for our patients in the clinic and hospital where I work, the pediatricians and subspecialists advocated for support of Child Life staff when administration wanted to make cuts.
Another outstanding speaker was Yale Smiley, MD, an alumni of the University of Minnesota residency program. The title of her presentation was “Moving Towards Diversity and Inclusion: Mitigating Implicit Bias and Its Effects.”
Guess what? We all have implicit bias.

Dr. Smiley stated, “On average, physicians are biased against certain populations at the same rates as the general public. This is despite having explicitly stated altruistic or egalitarian values.” There is an AAP taskforce on addressing bias and discrimination.

As we move forward and keep our laser-like focus on the health of children in Minnesota, let’s each do our part to minimize toxic stress and implicit bias.

“I am enough of a realist to understand that I can’t reach every child, but I am more of an optimist to get up every morning and try.” — Preston Morgan

Lori DeFrance MD,FAAP
MNAAP President

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